in response to letter by Finfgeld-ConnettVigilance: The Essence of Nursing
In Dr. Sherwood's metasynthesis of qualitative analyses of caring, she found that healing interaction, knowledge, intentional response, and therapeutic outcomes were important patterns of caring. We do not dispute that these are critical features of caring but they do not define nursing's distinctive position within the health care environment. Many health professionals claim these aspects of caring as essential to their practice. We believe it is vigilance that defines the unique role of nursing in health care. It is the nurse whose primary responsibility in any health care setting is to "watch out."
Vigilance is not assessment and evaluation. In the 2004 Scope & Standards of Practice, the American Nurses' Association (ANA) defines assessment as the collection of comprehensive data pertinent to the patient's health or the situation. Vigilance is the largely unarticulated state of mind that makes that data collection possible and meaningful. Vigilance is sustained attention, the ability to differentiate signals from noise, the ah ha moment that comes when something of significance is recognized. In a health care environment, machines or minimally trained personnel often "do" data collection. Vigilance is attaching meaning to that data and meaning is prerequisite to intentional response. The difference between assessment and vigilance is evident in the tragedy of September 11, 2001. Recent commission reports have told us that a plethora of data was collected but there was a failure to connect the dots to see the meaningful pattern behind that data. This was a failure of vigilance not a failure of assessment.
Vigilance itself is a mental process, a mindset, invisible to others. Because of this we submit that a new type of nursing diagnosis is necessary, one that attempts to make what we "watch" for more visible to others. As Dr. Sherwood states in her article, documentation of nurse caring is essential. Surveillance diagnoses give us a vehicle to make vigilance, a critical component of nurse caring, more evident to others.