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Good Housekeeping highlights "tender mercy" of homeless outreach nurse

January 2004 -- This month's issue of the widely read Good Housekeeping includes a long story by Elizabeth Gehrman about a former nun who has become a Boston homeless clinic outreach nurse. The piece is very positive, though it places more emphasis on emotional bonding than on the professional skills required to do the life-saving work of a community health nurse.

"The Tender Mercy of Cheryl Kane" reports that Ms. Kane spent her two decades as a nun teaching, counseling, and doing "pastoral outreach." While in her early 40's, she left her convent, enrolled in a nursing school, and later married a former priest. Unfortunately, her husband was diagnosed with a fatal brain tumor, and he later died. Meanwhile, Kane had graduated and begun work with a shelter-based Boston homeless program. She ultimately became part of a "street outreach program" staffed by a "street team" composed of two nurses, a physician, a physician's assistant, two "mental-health clinicians," and a researcher. For the past six years, Kane and a fellow nurse have provided care to the homeless on the streets of Boston.

To the article's credit, it notes that Kane and her partner "change dressings, remove sutures, treat skin ailments and body lice, take blood pressures, hand out condoms, and administer pregnancy tests and flu shots. They assess the conditions of patients who might need to get to a hospital, and they make referrals for detox or prenatal care." It also describes how Kane tried to persuade one patient to enter a medical program, how she treated another for immersion foot, and how she can be firm with patients when necessary. It does a good job of conveying the "cycle of despair and pain" her homeless patients face, and the sacrifices Ms. Kane makes to care for them. Though it does not actually say that Ms. Kane and her partner work autonomously, it also does not suggest otherwise.

But the main focus is on Kane's tender mercy, as she makes the rounds, finding her patients, getting to know them, soothing them, getting hugs from them, and providing, as she says, "an opportunity for them to speak about what's important to them." At one point, she gives a patient her deceased husband's coat. Kane also says that for her "it's all about looking into somebody's eyes and really trying to figure out what's going on. And knowing that underneath the skin, we're all the same. We all have the same desire to be loved and to be happy." Gehrman notes that Kane says "it's her homeless patients' gratitude that keeps her going--that and the belief that she follows a calling." The physician on the team adds that "[r]eal love and caring and giving is something that is denied you when you're out there struggling to survive. Cheryl plugs into that. She understands it."

These are fine qualities and sentiments, and they are useful in nursing, as in many other fields. But they do not create a good nurse, or else nursing school and professional experience would be irrelevant. In fact, nurses armed only with these qualities would result in a lot of dead patients. It is unlikely that an article primarily about a physician would have taken such a personal, emotionally oriented approach--indeed, while this article always describes Kane as "Cheryl," the team's physician is always "Dr. O'Connell."

We have nothing but admiration for Ms. Kane's work, and we commend Good Housekeeping for running a substantial article about it. We wish only that the piece had done more to convey the serious critical thinking and professional skills required to assess such difficult patients in this setting, and to provide nursing care in the face of the technical, economic and social challenges involved. We wish there could have been some indication that the work of someone like Ms. Kane can literally be the difference between life and death. The article contains hints that all this is going on, but more would be required to effectively communicate it to readers accustomed to thinking of nurses as "angels of mercy," but not as educated, highly skilled professionals who save lives.

For instance, will the average reader understand that when Kane looks into a patient's eyes, she is not just trying to understand them in order to provide emotional support, but as part of complex nursing assessments that will tell her whether he is following a treatment program, ingesting a particular substance, or suffering from a particular condition, and whether and how soon he may need to visit a hospital or clinic? Will they get that her look in the patient's eyes could save his leg, or his life? In a word: no.

On the whole, this piece gives the impression that Ms. Kane is a fine, empathic person who makes a difference in the often desperate lives of the homeless. Unfortunately, that is not an adequate description of what a good community health nurse does.