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'Caring is a fundamental part of the job, not an optional extra'

My father was in hospital after having had a severe stroke.

As I entered the ward for the first time, I saw a poster on the wall advertising “Making Time to Care”, which had been created by someone with the title of dignity nurse. The poster featured a number of ideas on how a busy nurse could create space in a busy schedule.

I was incredulous. I imagined boarding an aircraft to be faced by a poster with suggestions for the pilot about “Making Time to Concentrate”. I also envisaged entering my daughter’s school to see a poster advising people on how teachers might “Take the Time to Educate”. If I went into my bank and saw a poster suggesting ways in which the staff might “Make Time to Get the Sums Right” I would promptly close my account.

The essential element of a pilot’s role is concentration, a teacher is an educator and a bank has to demonstrate that it will not lose my money. These are not optional extras in an otherwise busy day, they are key functions. A nurse’s role is surely about caring? It must be the central task and not something to be done in bits of time that can be freed up.

The care my father received was good in so many ways and yet I arrived on the ward to find him lying naked on his bed in full view of others. This must have been humiliating for a dignified man. He was being called by the wrong name despite the fact that his notes made it clear what he preferred to be called. His Parkinson’s medication was changed - as a result of which his shakes became uncontrollable - and it took the threat of a complaint before his long-established medication was reinstated. His cards and photographs went missing.

None of these things was really a matter of time. Drawing the curtains takes seconds. Presumably the notes had been read but it had not registered with the nurses what he preferred to be called. I discovered that the change in medication had been a matter of cost to the hospital.

Whoever moved the photographs and cards did not care enough to remember to return them. None of these issues is really about time - each one comes down to mindfulness. They are about caring sufficiently to make sure that the things that probably mattered to him most were done.

My father did, however, have a lot of things done to him - things that he grew to dread and things that all the members of our family (he included) knew to be futile. The things done to him appeared to be the priority. His care seemed to epitomise task orientation at the expense of caring.

There appears to have been a flurry of recent reports of neglect and abuse being carried out by nurses in all specialties. The extreme cases illustrate an extreme lack of caring. Examples such as the one I’ve described here demonstrate a subtler lack of care, no matter how well-intentioned the nurses were. How do we put caring back at the centre of training and practice? Can we relocate “tasks” to a position of lower priority? NT

Steve Mee is senior lecturer, Faculty of Health and Well Being, University of Cumbria

Readers' comments (22)

  • you put caring back into nursing by employing nurses who care, by taking on students who care, you don't need a degree or formal qualifications to be a caring and compassionate person.

    open up student training for people who will be good at the job and who want to look after others.

    let's not have another degree nurse argument - just employ and train the right people.

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  • anon 6.31 - agree with everything you have said. nursing has really hit rock-bottom and things have to change. if this means going back to a non-academic course then great, let's not worry about anyone having to save face or having to justify their decisions - nursing is about looking after people, nothing more nothing less.

    looking after people can be at ward level or it can be at research level, it doesn't matter - nurses all have different skills and different interests but you have to start at the beginning - if you don't care then don't work in health.

    HCAs and student nurses should only be employed because they genuinley want to improve things for their patients.

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  • tinkerbell

    Anonymous | 29-Nov-2012 6:31 pm

    there are plenty of caring people in society without academic qualifications otherwise we would all be done for.

    I think a vital question that should be asked is 'why do you want to become a nurse?' In the answer somewhere should always be a desire to 'help others'.

    Unfortunately if nurses are left short of staff they can mostly only cope and coping is not the same as caring.

    Give us the tools and the majority of us will do the job.

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  • michael stone

    Steve has explained the things patients and relatives frequently see, and are upset by, very eloquently.

    It appears that some hospital managers, and some nurses and doctors, do not see these problems.

    As Steve says, it isn't solely down to pressure of time - but some of it might be a gradual erosion of 'the caring mindset' that results from working in an enviroment where nurses often have more tasks to complete than time to complete them in, over many years ?

    Although, of course, it is more complicated than 'just one thing'.

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  • I believe most of us come into nursing with the right caring attitude but have little control over the way we work. It's the staffing, leadership and organisation culture that influence what we prioritise. All I can do is try my best to treat people with care and respect as I run around like a headless chicken trying to keep them alive 1st and my job 2nd.

    While Steve has a very good point about general mindfulness, he is clearly very out of touch with the realities of nursing on most wards in most hospitals in the uk. e.g. 1 nurse to 8+ patients and senior nurses who offer no clinical support but keep ramping up the pressure.

    On the point of patient's exposing themselves, and lets be clear that is how it happens. I have never seen a nurse or HCA walk past a patient exposing themselves and not attempt to cover them in some way (curtains may not be appropriate as patient is the not visible). I have however seen a matron observe this and then look for the nurse to berate them about it instead of covering the patient first.

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  • A year ago I was a patient in a hospital in Swansea- there was another patient who had dementia who like to wander around the various bays. He was berated and hustled numerous times back to his bed, told to sit down and stay there. He became even more confused over a few days and then started to remove his clothing- again raised voices! He then stripped completely and wandered- the nurses took him back to his bed and dressed him, and then got bored- until eventually one busy morning- he walked to the nurses station naked and sat on the floor. The sister (!!) said to leave him there he would move when he got cold and told the cleaner to put a 'caution wet floor' sign at his feet and his head. He stayed there for a long while until I went out to the nurses station and demanded the nurses did some thing. This happened at least three times whilst I was a patient on that ward.
    Not one nurse stood up for that man, and after I asked for something to be done- they called for security to 'haul' (their words) him back to his bed!!!
    I trained in the 70's and have worked in the NHS and private sector as well as abroad; I have never seen such total lack of care, the 'C' word that nurses do'nt use anymore.

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  • I cannot belive that a patient can be treated like this. This ward and staff sound like another Winterbourne Veiw and they deserve to have action taken against them. Do they think they working in a concentration camp?
    I would like to think that you wrote a major complaint to the Matron/Director of nursing when you were well and out of hospital.
    Where has kindness and care gone to never mind the academiic qualifications.

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  • Anonymous | 2-Dec-2012 7:15 pm

    i was shocked to read your expierence. Can not believe that happened ( well i can) I too would have complaint.

    I know i was in charge once years ago on a ward and saw a soiled pad on the floor i observed for ten minutes, staff kept walking passed it in the end I did pick it up and dispoed of it, but i was surprised that other staff just ignored it. ( i was trying to see if anyone else had noticed it but obviously not)

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  • The Happiness Purpose by Ed. de Bono is a very helpful read in discovering ways of dealing with and more effectively managing your own personal 'self and coping space', that of others and the surrounding demand space which can be a major cause of stress and its consequences. Demands can be self imposed or forced by others and the environment such as expectations and goals which are too high. It also deals with the ego and detrimental effects of the over-inflated ego.

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  • The incidents and issues described above are very real and very shocking. I cannot agree more that something needs to be done but I'd like to reflect on two of the comments above....

    "...you don't need a degree or formal qualifications to be a caring and compassionate person..."

    "...let's not worry about anyone having to save face or having to justify their decisions - nursing is about looking after people, nothing more nothing less..."

    ...I mostly agree with both of those comments. However, if you think about it both of these imply a complete end to the nursing profession. If you don't need formal qualifications you don't need nurse training either. If you don't need to justify your decisions how can you be held to account? We hear the phrase '..too posh to wash..' a little too often but perhaps it captures a sense that for some nurses the fundamentals are beneath them? Are we also saying that you can be too clever to care? Nursing can't just be about caring - it has to be about caring + something else - knowledge, skills expertise and judgement. Crucially its about bringing those things together into the whole package. When I go to hospital or visit my practice nurse I want the nurse to be nice to me but that is not all i want/ If I just wanted people to be nice I'd go to my local corner shop where tea and sympathy are on offer in abundance. And when a nurse makes a decision that might affect my future health and well being I want to be very sure that they can justify it.... This is not about degree or not but it is about training and educating nurses properly and to a high standard. Like it or not this involves intellectual work that draws on and builds on basic education maths, english, biology, psychology and much much more....

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  • Matilda McCrrimmon

    Although it would be unrealistic to believe that the entire nursing profession is either caring or uncaring ,I personally am frustrated by not being able to care to the best of my abilities. The dependency of my patients has increased year on year with no corresponding increase in staffing. During the years of additional funding for the NHS most increase in nursing posts went into Specialist Nurses to support the EU working times Directives for medical staff and no increase in ward staffing. The corresponding changes in societal expectations and increased fear of litigation has also increased the documentation required to support the care given . The lack of time to provide support and training to new Health Care Assistants and mentoring Student Nurse mean good practise is not being passed on.
    With financial tightening and reduction in " back room " staff jobs which were taken off the nursing workload are now coming back. Despite all the above I endeavour to give the best care I can with a smile and kind word but regularly go off shift thinking I wish I had been able to do more.

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  • I retired 2 years ago after being in nursing for 40 years. Yesterday I was a patient undergoing an Endoscopy. I swas obviously apprehensive as I had never undergone this procedure before and had heard quite a few horror stories.I was taken into the endoscopy room and throughout the whole procedure not one word of reassurance was spoken to me Noone knew I had been a nursing sister. The nurse asked me had I had thisd done before and when I said No she said "why are you having sedation then!!".I said it was because people had said that it wasnt pleasant. She then put the tourniquet on my arm and pulled it quickly so tight that her arm was fully extended.She never spoke to tell me what she was doing When the cannula was put in she then said I will have to spray your throat.The Doctor the said he was going to inject a sedative Those were the only words spoken to me throughout the whole procedure I was made to feel a complete hindrance because I wanted sedation It was obviously an extra job for the nurse and she made me feel like a wimp In the 40 years of nursing I have never treated any patient the way I was treated with such an uncaring attitude from the nurse plus the Doctor.If this is nursing today may I ;please have no further need of a Hospital.The more I think about it now I wish I had said something for the sake of other scared patients who need reassurance and a nurse who will make them feel at ease not make them feel a hindrance Its disgusting

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  • tinkerbell

    Enid Martland | 4-Dec-2012 10:18 pm

    sorry you to hear you felt like a nuisance. A smile and soft word costs nothing. Sometimes we can forget the basics. They say that nurses make the worst patients, i try never to let them know i am a nurse if i'm having some work done on me but they probably know.

    I got very anxious about having a signoidoscopy recently, as i thought i was just going for a consultation, next thing i was up on the trolley. Although i never said anything at all during the procedure, not even when asked 'are you alright' as i felt if I opened my mouth all that would come out was a scream, they knew i was in a bit of a state about it all. The consultant was very pleasant about it all afterwards and told me 'you would never tolerate a colonoscopy' and i agreed with him wholeheartedly. What a relief! at that point i thanked him and try to make a bolt for the door thinking we were all done and dusted and he said 'hang on a minute, we haven't finished yet'.

    I have met some really caring kind nurses with some of my most recent ailments but i do know that we can all get burnt out and desensitised to others anxiety about procedures, but that's where we need to probably express our concern as the patient and say as i do 'sorry but i'm very anxious about this' and then i find it tends to bring us all back to the here and now as human beings and remember that although it might be just a normal routine for us as nurses and doctors for the person on the receiving end it isn't very pleasant at all and a new experience.

    I have come to realise that i am a bit of a wuss when it comes to having anything done to me of such an intrusive nature but strongly feel that if the procedure is explained to me every step of the way i would probably be a lot better as a patient. Some patients might prefer not to be told everything that's happening to them as it happens but i do.

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  • Florence

    Caring and being mindful is at the heart of what we do. Its these things that make a '' Good Nurse''. We do need the right resources to enable us to enable us to be able to do these things.
    I would rather go off duty late, and complete my papaerwork afterwards, and know Ive done a good job than appear to be '' Miss Efficient'' getting off bang on time.
    I realise its not all down to resources. Nurse learn by example as well as having the right caring attitude to begin with.
    While I wont argue that poor resources can wear down the best of Nurses.
    When I was a a hospital patient ( having Kyle) . I remember clearly the Midwives and support Staff who were not only professional and did their jobs well. But those who were kindly and thoughtful.
    I think Ive mentioned Tracey and Jill the amazing Practice Nurses who care for my Mum and Dad. Mum has a choronic chest condition and Dad has asthma and hypertension. These Nurses are not only professional, highly skilled and knowledgable ( I think Jill is now a Nurse Prescriber). They are genuinley caring. They regularly ask Mum & Dad how I am and even how my little Boy is!
    I absolutley agree with Tinkerbells comment that '' Coping is not the same as caring''.
    Im very lucky that I work in a ward where the culture is brilliant and there is real evidence of caring.


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  • Florence

    And Enid. Im sorry you had such a poor experience.
    A liitle kindliness and a proper explanation of procedures is the very basics which we all deserve to recieve.

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  • tinkerbell

    Florence | 5-Dec-2012 12:31 pm

    Florence

    Do not take life too seriously, you will never get out of it alive.

    Just an aside to your motto 'Calm you shall keep and carry on you must', i found a little book at work the other day called 'Now panic and freak out'. It has some wonderfully funny/serious quotes in it on how to cope with life.

    e.g., Caution: cape does not enable user to fly. (Warning on a Batman costume).

    I hope life isn't a big joke, because i don't get it.

    I owe my success to having listened respectfully to the very best advice, and then going away and doing the exact opposite.

    Make somebody happy today. Mind your own business.

    I have been taking this book round with me to the nursing homes i visit and showing it to some of the stressed nurses i meet as an ice breaker and there are a few of them ordering it as a christmas gift.

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  • I am certainly not a wimp I would have just liked a kind word not a signof aggression with the touniquet and being made to feel I was a nuisance because I wanted sedation

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  • Enid, it doesn't matter. even if patients are wimps or anxious or frightened. that is their right as well as it to receive good care by appropriately skilled staff in interpersonal relationships as well as in their practical abilities. without such skills these medical personal are totally inadequate. they have a duty of care to all of their patients and an ability to tune into their psychological/social needs and sensitivities. this is fundamental to decent human behaviour, respect for others and good socialisation and manners without which they should not be providing any services where they have direct client contact whether it be medical treatments or any other.

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  • Clearly you have touched a nerve. I have spent more time that I would have wanted in hospital with dieing relativesboth my mother who died from a stroke, her sister who died from cancer and my brother who died from cancer. The experience in the main, was not good. Yes there were some very caring nurses but also a lot that were rushed and did not have the time to talk, to feed, to take to the toilet, to give water when required. The agency nurses were especially uncaring. Some people are natural carers and others are not and the latter should not be employed as nurses. I dont think you need a degree to be a good nurse. If you have the right aptitude and a good standard of education then you can learn on the job. No degree is going to make you a good carer.

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  • safeandnsound | 7-Dec-2012 5:34 pm

    "No degree is going to make you a good carer."

    Neither does not having a degree make you a good carer.


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