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.