Narrative Inquiry in Bioethics

As a new graduate nurse working in the field of rural healthcare, one of the first lessons I learned was that the culture of Montana, including its people, are as wide and varied as the landscapes across which this great state lay. I live in a state where it is not uncommon to care for agriculturalists and ranchers injured by farm equipment, on any given shift. I work as much with Native Americans, performing smudging ceremonies to promote healing, as I do with family members who have called in priests to perform last rites to those on comfort care. I have been in countless rooms of patients who have been kicked by or bucked off horses, only to be left lying in a field until found by a worried family member. I [End Page 108] have seen my fair share of outdoor enthusiasts who have crashed into trees and rocks, or rolled over in an ATV, breaking bones and fracturing ribs. The landing pad located on the roof of our hospital is constantly inundated with helicopters flying in and out of our facility, bringing patients isolated in an otherwise wild and unfriendly territory to recover in one of our beds.

The intersection of nursing and rural healthcare comes with an array of challenges. While we face many of the same uphill battles as those working in urban and metropolitan area hospitals and clinics, some of our greatest difficulties come from patients who have neglected their personal health due to a lack of access to affordable, quality care. They may have a lack of providers from which to obtain care or a lack of health insurance. The chronicity of vice—tobacco, alcohol, drug use, sedentary lifestyles, poor nutritional and dental health, lack of familial support and obesity (amongst others) creates a detrimental force from which, in the face of significant trauma, many patients struggle to overcome.

As a night shift RN at my current hospital in western Montana, one of my first encounters with the challenges facing many rural healthcare providers was with an adult male in his thirties named, ‘Michael.” The first time I laid eyes on “Mike” was as a new nurse—new to the hospital at which I was (and still am) employed and new to the field of nursing. I hadn’t even completed my new graduate orientation yet. I was innocent to the field and had not yet learned that clinical rotations during school were quite dissimilar to the experiences I would have after graduation.

“Mike” had arrived via life-flight to our neurology and orthopedics unit with a traumatic brain injury. He had been in the backcountry, a few hundred miles outside our city limits, felling trees with his girlfriend to cut and sell as lumber. Although little history was given, it was understood his girlfriend had been above him on the slope cutting logs when one of them went rolling uncontrollably down the hillside. “Mike” looked up just in time to see a giant section of lumber come pummeling directly into his path. Immediately after, his girlfriend had somehow managed to find a small pocket of cell reception and called for help.

I assumed care of “Mike” a few days after his admission to our unit. I remember the feeling I had on first walking into his room. As a new graduate, a sense of overwhelm and utter fear plagued many of my visits to patient rooms. Will I do the job asked of me? Can I perform the tasks expected of me? I ruminated on these questions and others as I interacted with my patients suffering lesser degrees of injury and with cognition far more intact. My desire then, as it is now, is to promote safe, holistic, person-centered care. I was eager to apply interventions, to create goals, to witness successful outcomes.

On seeing “Mike,” I second-guessed all that I had achieved up to that point. He had lost all his front teeth; his beard and mustache were crusted with dried blood. A PEG tube had been placed because his sinus cavity...