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Practice comment

"Why don't we ask patients what they thought of their care?"

Entering into a dialogue with patients about the care we give would result in meaningful feedback

Recently, a nursing survey requested nurses’ views on several issues they face today. It’s interesting to see these include the lack of compassion in some nursing staff and inadequate standards of student education. Interesting also to reflect on how these issues may impact on another identified in the survey - namely the increasingly poor image of nursing in the media. In the public’s eyes, nurses seem to have gone from angels to, perhaps not devils, but certainly a beast of equally hard skin and unsympathetic soul.
It is normal for people to seek caring relationships. Illness and the unfamiliar situations that accompany it don’t diminish that need. Unsurprising then, that the public reports feelings of frustration, anxiety and even fear when caring interactions with nurses are infrequent or absent. Opinion seems to be that nurses are less compassionate than in the past. Why might this be so?
Inadequate staffing must play a role. It seems a “no brainer” to me that large workloads and patient-staff ratios result in care that is, at best, perfunctory. Unnecessary and repetitive documentation also don’t help. But perhaps a key contributing factor lies elsewhere. Many students and their mentors feel nursing education has become too fixated on academic achievement, and quantitative assessment of nursing skills alone does not provide enough evidence of a student’s competency as a nurse.
A change in training emphasis and indicators of competence for student nurses could produce better, more compassionate nurses. No one wants to abandon the advances made in promoting evidence-based care and skills training, but a shift in the balance would be welcomed by students, nurses and patients. We could, and should, refocus on basic caring values, attitudes and, most importantly, behaviours. And when we measure students’ competency we could also use qualitative evidence to measure “soft” skills such as compassion.
We all mentor student nurses. Instead of relying solely on ticking skill boxes and care competencies, why don’t we actually ask patients what they thought of the care they received from us and those we train?
One of the key parts of a compassionate and caring relationship is communication - that means listening as well as talking. Entering into a dialogue with patients about the care we give would result in meaningful feedback that could lead to improved care and mean we actually spend more time with patients (surely what most of us are in nursing for). The next generation of nurses could then learn how simple skills such as touch, empathy and a compassionate attitude really have positive outcomes for recovery.
This is not new. In 2008, health secretary Alan Johnson called for care and empathy to be rated with surveys of patients’ views. But this kind of retrospective “compassion target” is surely the last thing our overworked workforce, with its low morale, needs. Finding time to ask a patient in person to evaluate their care would be a lot more useful, interesting and relevant. Or are we scared about what we might hear?

Stephen Riddell is a district nurse working in Dumfries and Galloway

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Readers' comments (10)

  • Richard White

    Whatever happened to PROMS?

    Patient reported outcome measures.

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  • PROMS?

    why not care for patients and do a good job instead of worrying about all this meaningless management stuff to file in the archives until it takes up too much space and which gets ditched unread several decades later?

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  • What happened to patient feedback forms, monthly meetings for patient improvement involving patients, discussion with patients at the end of their admission to check they understand what is happening and has happened, trial steering committees for patient focus groups and much much more? These are happening in this trust so why ask this question? The trusts you looked at needs to improve, simple as that.

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  • more meetings and form filling doesn't necessarily constitute improved care. only contact with patients and bedside nursing can do that.

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  • with sufficient contact with patients and good nursing and excellent observation skills you can gauge their satisfaction far more accurately than filling in more forms and having meetings. nurses seem to have become totally obsessed with management methods which sometimes bear little relation to quality nursing care.

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  • Anonymous

    Anonymous | 6-Mar-2012 10:24 am

    'nurses seem to have become totally obsessed with management methods which sometimes bear little relation to quality nursing care.'

    The NHS in general seems very paper-trail obsessed - but does this stem from front-line staff, or does it flow downwards from managers who are actually distant from patients ? More to the point, is it possible to address this issue ?

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  • I could not agree more... I feel that nurses have too much documentation and less time with the patients. If nurses look like they are coping then they will add more to the work load. I admire what the nurses do and realise most want to spend more time with patients. I understand that nurses normally don't have breaks and don't go home until late because of the amount of written work. Managers need to spend most of their time on the wards to see how to improve.

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  • I'm a bit dim but ... | 6-Mar-2012 10:28 am

    from Anonymous | 6-Mar-2012 10:24 am

    I should think it comes from general and nursing management and nurses on the front line are left with little choice but to do whatever is dumped on them whether they agree or not but the obsession does seem to get fairly deeply ingrained. those who brought up with this system give the impression that they find it fairly normal!

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  • Anonymous

    Anonymous | 8-Mar-2012 9:08 pm

    I agree with you. Cameron et al are now saying that Ward Sisters, etc, need to have more control over what happens on their wards - that would involve being able to challenge the imposition by senior managers of largely pointless paper-trails, etc, but I have my doubts that Cameron's words will turn into practice !

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  • I'm a bit dim but ... | 9-Mar-2012 3:17 pm

    from Anonymous | 8-Mar-2012 9:08 pm

    Agreed. It always used to work with sisters in charge of their wards so why shouldn't it work again?

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