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OPINION

'Having a smoke with your client used to feel like good nursing'

  • 7 Comments

You know those conversations you have with friends where you compare mildly embarrassing things you have done, or omissions from your life that may surprise others?

Small insignificant truths and oddities like “I have never eaten a kebab” or “I once accidentally snogged Princess Caroline of Monaco”?

And then someone misjudges the line between minor idiosyncrasy and too much information, following “I once tasted dog when backpacking around Asia” with “I ate your dog. You remember Freckles the terrier? I ate him.”

Well, I may be just about to do that.

In the olden days, it was not unheard of for me to assess the mental health of a client while sitting drinking coffee and smoking a cigarette with them. We’d sit, puff, chat and I would get a sense of how they were through thin clouds of amiability and tar.

It was convivial, normal … oh what’s the use…. Seen through the prism of modern- day nursing, I am a bad person. I can hear the Nursing and Midwifery Council ninja squad warming up their mopeds as we speak. I not only colluded with unhealthy life choices but I also modelled them.

Even though this was more than 20 years ago, it is not as if I didn’t know smoking was unhealthy. Hell, the more I think about, it the worse I feel. As soon as I have finished typing this I will turn myself in.

Of course, loath as I am to defend bad behaviour, it felt like good nursing to me, as did sitting in a pub with clients on occasion or going shopping with them for weekly supplies of pork scratchings and trifle. Engagement first, everything else second.

But, of course, our idea of modelling health is more sophisticated these days, or at least laden with a different idea of professionalism.

Addressing the NHS Confederation conference last week, the head of community services in Leicester said that district nurses often set a “rubbish” example to patients around healthy living and raised, again, the long-running debate about the extent to which nurses need to model good health as well as advocate it.

In principle, we know it helps. When I worked in general practice and was running quitting smoking groups, I know that the fact that I had (with difficulty) given up smoking helped me to be useful - more useful certainly than if the members had found me puffing away out back afterwards.

Nurses are never invisible; nurses are always seen, always noticed and always judged - for better or worse - which makes the task of modelling good health both more complex and more pressing.

There are a couple of caveats to modelling, aren’t there? For one thing, it is crass to imagine that nurses should model joylessness. If a patient has made health choices and is choosing to live with the consequences of those, it is not a nurse’s place to punish or judge them, is it?

Piety in the face of other people’s ill health can be at best insensitive and at worst ugly and cruel. If someone is dying of chronic obstructive pulmonary disease, is a stop smoking lecture and doing some press-ups to show them how well you are the best intervention?

Second, if we want nurses to model good health, nursing should be organised to enable good health for nurses. While the days of subsidised health clubs have long gone, managing and addressing the stresses and pressures of nursing needn’t have. If nurses need to model good health for patients, then organisations need to model good health maintenance for nurses. One can only hope they do that properly.

 

 

 

 

 

 

  • 7 Comments

Readers' comments (7)

  • Well said Mark. I remember those days with fondness and affection. Patient contact really meant something then.

    I agree totally with the statement 'Nurses are never invisible; nurses are always seen, always noticed and always judged - for better or worse - which makes the task of modelling good health both more complex and more pressing.' Take for example the nurse who is out shopping with a cardigan covering the work uniform. You can hear people whispering behind them saying 'Shouldn't she take her uniform off before food shopping?'.

    Then there is the ex patient who remembers you from 10 years ago as you were the nurse who really changed their life.

    Or you are on a day off, enjoying browsing the stores and someone collapses. Now some might shout I am a nurse, get me in there, I personally think, I don't want to be a nurse get me out of here. Not because I don't want to help - far from it, but I have got used to having a full crash team behind me, the equipment close at hand to diagnose what is wrong with the patient and I have the hospital legislation and protocols to fall back on to make sure I am doing it correctly.

    THEN I remember that I should help a person in distress because I have the extra knowledge the general public don't (and secretly there is a voice at the back of my mind saying what if someone recognizes you as a nurse and reports you walking away). It is a tough call to make and I have looked after a few people knocked down by cars, beaten to almost insensibility by other drunken party goers and the generally very unwell (cardiac arrest in a shop) types and I think that this is what I do and I hope people realise that I am doing what is best for the person, which is generally nothing apart from maintain an airway until the ambulance arrives, and I try to calm down their friends.

    My friends respect what I do and admire that I know things they don't. It sometimes is a nightmare having this pressure when a member of the public is unwell (especially babies) but people are watching and wondering what nurses will do next. Scary but that is the choice of a nurse, act professionally or don't be a nurse

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  • I started smoking 33 years ago solely so I could have a smoke with the patients and engage with them.

    Took several attempts to give up when I realized how much damage it was doing!

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  • Ellen Watters

    I too remember having a smoke with a patient who had just been told that his cancer was no longer responding to treatment and nothing further could be done. Smoking was allowed in the dayroom in those days. He asked to borrow a cigarette and we sat together and he broke down and all his fears and anxieties came pouring out.

    I had been looking after him since diagnosis, I was there for him when he was told the devastating news and I was there when he finally passed away. I felt privileged to have been a source of support to him at his most vulnerable time..And at the time sharing a cigarette broke the ice a little and allowed a very frightened patient to perhaps let his guard down.

    I stopped smoking 4 years ago but will always remember that particular incident with no regrets.

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  • George Kuchanny

    Thanks Mark,
    A warm hearted and strangely uplifting article with comments to match. It is what being human is all about and quite possibly the essential core of what being a nurse really is

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  • To be honest I was always a bit envious of the mental health nurses being able to spark up a fag and a conversation with a client as part of the 'looking after'. Partly as I didn't smoke but partly as I was in a different branch of nursing, the Hattie Jacques School, and couldn't have been further removed from what you describe even on another planet.
    I was watching someone being completely derided this morning for providing a service that helped comfort people and make them feel a bit better in their distress, because it wasn't scientifically approved and dissected to within an inch of its life. The helping someone feel better seems really to have been not only lost but devalued in the name of science and protocol. Very sad.

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  • is there any scientific evidence in the nursing knowledge base to prove that it is beneficial to talk to patients? As students, if we were caught 'idling' with patients this was immediately perceived to be skiving and we were provided with a series of menial tasks, not really related to patient care or learning, to keep us constantly occupied throughout our shift!

    It requires no imagination to understand the detrimental effects of this behaviour on patient care, as well as the opportunity for students to gain experience and build up self confidence! I believe that whether it is a serious discussion, information gathering, psychosocial support, patient education or small talk which can both patient and staff at ease, all are important and there is nothing worse in trying to deliver this aspect of care effectively with constant interruptons.

    Later in my career a computer nursing diagnosis told us if a patient was suffering from a psychosocial problem (in case we were unable to detect this for ourselves) and how much talk time they needed. we had to document this using a point system for the number of minutes, not to be exceeded, to determine staffing needs for the following day (which it clearly had absolutely no influence on!).

    Managers seem to fail to understand, or ignore the fact, that talking and excellence in communications is a large and vital part of a nurse's role.

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  • Anonymous | 24-Jul-2011 5:01 pm

    you don't have to 'idle' with patients if you deliver patient care. That gives you ample time to talk and more importantly listen to them. So, you can keep busy and spend time with your patients. However, I was pleased to read your final comment, 'Managers seem to fail to understand, or ignore the fact, that talking and excellence in communications is a large and vital part of a nurse's role'.

    As for,'Later in my career a computer nursing diagnosis told us if a patient was suffering from a psychosocial problem (in case we were unable to detect this for ourselves) and how much talk time they needed. we had to document this using a point system for the number of minutes, not to be exceeded, to determine staffing needs for the following day (which it clearly had absolutely no influence on!).'

    Is this our future? God help us! Having said that, years ago we had 'monitor' (not to be confused with the current concept) that the NHS spent thousands on, if not much more, determining 'patient dependency' for the required staffing levels for the following day. As the results showed we needed more not less staff, it was eventually abandoned - no surprise. However, this computer system is telling you what time to spend on patients, not the other way around. Do you know how they came upon these timings? What comes next, how long you have time to feed a patient, change a wet bed, take someone to the toilet, time a patient takes to take their medication... the list is endless, not to mention very scary.

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