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“Practical skills must be taught to ensure compassionate care”

Recent reports into poor care have led to a heated debate about compassion in nursing. Many have characterised compassion as a personal characteristic or value that has been lost as nursing has moved away from vocation and towards a knowledge-based (and therefore university-based) profession. As a nurse with a doctorate, I can’t accept this argument.

It cannot be denied that there have been appalling failures in which personal care has been poor or absent; however, there is no evidence that nurses are less caring than in the past and certainly no evidence that student nurses have the wrong values. So why does poor care sometimes happen?

Compassionate care requires the right values and motivation but it also needs the knowledge and skill to deliver dignified care. For the last 10 years, the NHS has been driven by a desire for productivity and efficiency with a focus on completing tangible (and measurable) technical tasks. The number of nurses needed has been calculated on the number of tasks to be completed, with personal care seen as unskilled and undervalued. It is therefore not surprising that some patients feel distressed when intimate care, such as washing, help to use the toilet and help with eating and drinking is undertaken in a manner that compromises dignity.

The government’s response has been to lay the blame on nurses and to recruit for specific values and make potential student nurses work as healthcare assistants for a year. This neglects the importance of compassion as a skill that can and should be taught. Providing intimate care for someone with whom you don’t have a relationship, and who is sick, vulnerable and maybe distressed, is a highly skilled role. As with all complex skills, becoming an expert requires a thorough understanding of the theory and extensive practice.

We recruit wonderful student nurses, but I’m not sure if we always equip them with the skills to provide compassionate and dignified care. When I started training, all nurses followed a standard pattern set out by the General Nursing Council, with three months spent in preliminary training school. As well as learning anatomy and physiology, we were taught the skills of personal care, spending hours learning how to give a bed bath and turn people with dignity. We continued to receive supervision in the delivery of personal care during ward placements. Total patient care was the first of the four formal assessments required to sit the final examination to become a state registered nurse.

Universities provide excellent simulation experiences, but I don’t know how the Nursing and Midwifery Council checks that students or overseas registrants have these practical skills to a common standard. Thousands of excellent students become nurses, but NHS complaints suggest others are falling through the net.

If nurses are not given the opportunities to develop their practical expertise to match their values and motivation, we cannot criticise them if patients and families complain of a lack of compassion. NT

Elaine Maxwell is trustee at the Florence Nightingale Foundation

Readers' comments (7)

  • In many parts of the world nurses do not provide "personal care" it is the patients family
    who take care of personal hygiene, feeding etc.

    Recruiting nurses from countries where the culture of care is very different to that which prevails in the UK is a mistake and will inevitably lead to diminishing standards of "care" within the NHS

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  • good point Jenny, I wonder if all the Trusts that have been recruiting abroad, of late, have really thought that through...doubtful, another quick fix, one thing the NHS is good at!

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  • Whilst I agree that one can teach how to give good dignified care to patients, I do not think one can teach 'compassion'. Either one cares about others - or one doesn't. I have met many very compassionate, intelligent and skilful students, but I have also met those who are cold towards other staff and patients and who do not accept they are lacking in any way. How would they know, they have always been like that (presumably). Surely it is up to us as mentors to identify those not suited to a caring profession as soon as possible - but how many of us do????

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  • Time was when holistic care was all important and it was right to do everything for your patient, now it is all broken down into tasks with nurses being told to do what is 'grade appropriate' and unfortunately it's personal care that is seen as not requiring trained nurses.

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  • Compassion cannot be taught, it is an innate quality, such as empathy and love, and not something that can be drummed into a student in the classroom like a robot.

    You cannot teach someone compassion who does not have feelings for another creature, be it human or animal. You can teach someone to wash a patient keeping their dignity intact, using mechanical method, as you can teach someone processes on a conveyor belt. But caring and concern for the patient comes from the heart, not just by being able to perform practical skills well.

    There have always been nurses who were not compassionate, rude and uncaring; and who had little sympathy for a patients condition. My gran was a qualified red cross nurse after the first world war and my mum was one of the first NHS nurses in the late 40's, and they have seen plenty. I have seen many discompassionate front line health care workers during my many years in the profession. It is not a new phenomenon.

    To level the ills of the health service on "modern" nurses and the denigration of young nurses in rags such as the Mail and the rest of the media is a clever diversion from what is really happening within the NHS, such as mismanagement, running down the service ready for privatisation; and underfunding with ever increasing demands and higher expectations of the general public.

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  • No one comes into the job wishing to treat the people with unkindness and a lack of compassion.
    You can't teach compassion?
    I think you can teach the skills required to deliver care compassionatly - when I have seen uncompassionate care is is always a lack of underpinning knowlege that is the root cause - if you do not understand dementia and your patient is aggresive towards you the compassion will start to drain as you interpret the behaviour as personal to you and not part of the disease process.

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  • The question of whether compassion can be taught is very interesting - I would recommend the work of Daniel Siegel (plenty of links via Google). The brain (which he defines as the entire nervous system, not just the neural ball atop our necks) is plastic and character traits can be nurtured and developed given the right milieu. And that's the challenge - providing environments that enrich people rather than whittle away the potentials almost all of us have for care and compassion.

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