How do patterns of knowing in nursing emerge from this movie?

Patterns of knowing in nursing emerge from this movie by the ways that Vivian and Susie interact. Contrasted with Vivian's doctors, Susie is compassionate and empathetic towards Vivian's suffering. By using emotional intelligence and observation, Susie asks questions at the right time and in the right tone. For Vivian, an emotion-based approach to patient care is better than a clinical and academic one.

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In the movie version of the play “Wit ,” patterns of knowing in nursing emerge through nurse Susie Monahan’s interactions with Vivian. Throughout their shared scenes, Susie observes, listens, and asks questions to learn what Vivian feels and needs, both physically and emotionally. These patterns of knowing demonstrate Susie’s...

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In the movie version of the play “Wit,” patterns of knowing in nursing emerge through nurse Susie Monahan’s interactions with Vivian. Throughout their shared scenes, Susie observes, listens, and asks questions to learn what Vivian feels and needs, both physically and emotionally. These patterns of knowing demonstrate Susie’s emotional intelligence in her nurse-patient bond with Vivian.

During their initial meeting, Susie reenters the exam room to find Vivian on the table, her feet up in stirrups for a pelvic exam. Immediately understanding and knowing that Vivian would feel embarrassed and vulnerable, Susie asks clinical fellow Dr. Jason Posner incredulously, “What is this? Why did you leave her—?” Throughout the pelvic exam, Susie keeps her eye on Vivian’s face to watch for signs of any discomfort and then observes her gasp as Jason roughly pulls his hand out of her. Dr. Posner is oblivious to his own ineptitude, but Susie knows that the pelvic exam was both painful and humiliating. She silently hands Vivian a tissue to wipe herself before turning away.

In a later scene when Vivian calls Susie, the nurse immediately asks “Having some nausea?” because she anticipates how Vivian feels. After Vivian vomits, Susie matter-of-factly measures the amount of vomit to check Vivian’s progress; more importantly, though, Susie listens to and observes Vivian’s behavior. Having noticed that Vivian has had no visitors, Susie asks, “Is there somebody you want me to call?” When Vivian says that she does not want any visitors, Susie tells her that she will pop in once in a while to check on her. Susie seems to know that Vivian is trying to be stoic and independent, yet still needs help. She touches Vivian’s arm and emphasizes, “You just call.”

Later when Vivian arrives at the hospital feverish, shivering, and anxious, Susie observes her behavior, notes her vital signs, and knows that the experimental treatment’s high dosage has been “too much for her like this.” As the nurse, however, Susie is overruled by Jason. He wants to continue Vivian on the same high dosage.

As Vivian’s deterioration progresses further, she grows sicker and more afraid. When Susie is alerted to check on Vivian at 4 in the morning and asks, “Can’t sleep?”, Vivian admits that she just keeps thinking. Susie replies, “If you do that too much you can get kind of confused.” Through “Wit,” Susie does not rely on overthinking in order to know Vivian’s condition. Instead, she observes, listens, and uses emotional intelligence and empathy to understand her patient. By asking Vivian “It’s like it’s out of control, isn’t it?” Susie demonstrates that she senses Vivian’s present fear and acknowledges Vivian’s former feeling of being in control of her life and others. In order to address Vivian’s fear and self-doubt, Susie knows that a tissue, a popsicle, and a childhood story would be comforting to her. Susie also knows that this is the time to ask Vivian her wishes regarding a Code versus DNR order. Vivian seems emotionally ready for the difficult question, and her physical condition is worsening.

Susie comments that doctors and researchers “always want to know more things.” Nonetheless, their way of knowing or gathering knowledge comes at the expense of others' needs. In “Wit,” Dr. Kelekian and Jason want to keep Vivian under a grueling experimental treatment even when she suffers greatly. They prioritize knowledge over compassion. When Vivian is in intense pain, Susie knows that Vivian would feel better to be in control of her pain management medicine. She argues with Dr. Kelekian to give Vivian a patient-controlled analgesic instead of morphine. Susie demonstrates that although nurses may not have as much advanced scientific knowledge as doctors do, they possess knowledge of basic medical treatment and emotional needs of patients.

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If we look at "knowing" in the context of "clinical judgment," Wit and the character of Susie Monahan provide great insight into how nurses "know." In the film, Vivian Bearing's character is consistently degraded by her literal cancer treatment and the treatment by the physicians attending to her. Her physicians are purely clinical and have no real regard for her quality of life. Contrasting this treatment is the treatment she receives from her nurse, Susie Monahan. Susie does not operate on a purely intellectual or clinical level; rather, her quality of care is dictated by her own beliefs as a healthcare provider and as a human being. Susie is an incredibly powerful character in the film because of how she advocates for Vivian and how her "knowing" is less dictated by clinical judgment and cognitive theory than by experience and an innate humanness.

Ultimately, this is symbolic of the consistent debate in the medical community as to how to provide the best clinical care. On one side, there is the idea of "academic" medical care, which functions as a way to provide treatment purely based on data, scientific theory, and so on. On the other side is medical care rooted in experience. In Experience in Nursing Practice, Benner, Tanner and Chesla argue that expert nurses hold the ability to understand abstract clinical concepts and balance them with past experience to provide a greater sense of "knowing." This enables nurses not only to treat their patients and provide positive healthcare outcomes, but to connect with their patients and provide the best quality of care. Susie Monahan does this throughout the film, as she is not an intellectual or an abstract theorist as the physicians are, but a caregiver and a nurse, a profession which requires skill, but also an innate human care.

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