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Using humanising values to support care

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This article uses a patient scenario to demonstrate how recognising and valuing humanity in all our interactions can be used to instil compassion and dignity

Abstract

National responses to the Francis report recommendations call for a stronger emphasis on the service-user perspective. This article uses a client scenario to reflect on how dehumanised aspects of care can become humanised by basing our practice on a humanising values framework, and argues that the framework can, despite the system, provide a guide to support us “to do the right thing”.

Citation: Scammell J, Tait D (2014) Using humanising values to support care. Nursing Times; 110: 15, 16-18.

Author: Janet Scammell is associate professor; Desi Tait is senior lecturer; both at the School of Health and Social Care, Bournemouth University.

Introduction

Although for most health professionals, providing excellent care based on humanising values is central to their practice, a number of recent reports about poor-quality healthcare have criticised the NHS.

The Francis (2013) report into care failings at Mid Staffordshire Foundation Trust showed how a focus on meeting targets and a failure to perceive and respond to patients’ basic human needs resulted in poor-quality care. The serious case review into care of clients with learning disabilities at Winterbourne View Hospital (Flynn, 2012) demonstrated the impact of a culture where staff treated people as objects, denying their humanity. The undermining of clients’ dignity seems to be at the centre of these reports. However, as individuals, the vast majority of nurses fervently express core values such as compassion, care and commitment (Kitson et al, 2013).

Responses to these reports have been widespread and their implications are reflected in nursing and midwifery strategies across the UK (NHS Education for Scotland, 2013; NHS England, 2013; Welsh Government, 2013; Department of Health, Social Services and Public Safety, 2011). All highlight similar key components: patient safety, quality and effectiveness of care and the patient/client/service-user perspective.

Compassion in Practice (NHS England, 2013) focuses on promoting positive action through the use of the 6Cs, which summarise core values that are also evident in the Nursing and Midwifery Council’s (2008)code of conduct. However, to be more than a set of labels, these values need to be situated in an approach to care. Treating others (service users and colleagues) in a way that respects their humanity would become “a way of being” rather than a guide to follow.

What does humanising care mean?

Galvin and Todres (2013), who developed a humanising values framework (HVF), suggest that attention to the “things that make us feel more human” is missing from healthcare today. They explore what it means to be that underpin healthcare policy, as illustrated in Compassion in Practice and health professionals’ codes of conduct, are derived from valuing humanity in all our interactions. Humanised care builds on these foundations (Fig 1).

Recognising human values in practice

The HVF is not a model of care but more an approach to everyday practice. Building on the essences of humanity, it identifies eight philosophically informed dimensions of humanisation that constitute a value base to consider the potentially humanising and dehumanising elements of caring systems and interactions. The framework is explained in more detail elsewhere (Hemingway et al, 2012; Scammell et al, 2012); we illustrate its application to nursing practice through the use of a patient scenario (Box 1).

Table 1 summarises the humanising dimensions of care and their meaning; when these are denied or ignored, care can become dehumanised (Table 2).

Care through the patient’s eyes

This section analyses the scenario in the context of human values and explores whether using the HVF can help people to do “the right thing”. The analysis includes reflecting on the relationship between Bronwyn and Glenys, the GP and the nurse.

Bronwyn and Glenys

Bronwyn and Glenys had lived different and separate lives before Bronwyn moved to England. Bronwyn now lives with Glenys, who appears to have become protective of her. However, Glenys’ desire to protect and care for her sister led her to make assumptions about what is best for Bronwyn; she ignored Bronwyn’s sense of insiderness and agency and made an appointment for her with the GP without consulting her.

By taking charge and losing sight of her sister as a person, Glenys had nurtured a type of passivity and isolation. In response, Bronwyn reluctantly accepted the appointment, adopting a passive approach and accepting her loss of ability to make her own choices. Her approach changed, however, when she realised the GP was male and she decided she was not going to share any personal information with him. Bronwyn’s public self may have presented calm, open behaviour but her inner experience was full of feelings of fear and embarrassment, manifesting what Heron (1977) describes as the desire to control rather than express profound emotion.

Glenys had been married for 45 years and did not see the significance of a male GP to her sister. A more humanising approach would have involved Glenys recognising Bronwyn’s insiderness, trying to see things from her point of view and developing a shared understanding of how to resolve the problem. Bronwyn, accustomed to making her own decisions, could have shared her problem and tried to be more open about her concerns. Her personal journey has been very different to that of her sister.

GP and Bronwyn

The average GP consultation lasts 7-10 minutes (Gude et al, 2013); the aim is to identify and focus on the patient’s medical problem and to make a diagnosis. The initial focus is on biological signs and symptoms, with psychosocial aspects addressed in the latter stages (Gude et al, 2013). The GP’s focus was reductionist - he made assumptions about the type and location of Bronwyn’s pain, which were not verified by a clinical examination as Bronwyn refused this. The consequence of this was a misdiagnosis of her problem and her subsequent emergency admission to hospital.

Bronwyn had been anxious about meeting the GP and her coping strategy had been to retain her personal agency and reduce her feelings of vulnerability by refusing to be examined. The GP, by recognising Bronwyn’s insiderness and uniqueness, could have focused on person-centred communication with a holistic assessment. A more empathetic response would have been to offer a chaperone for a clinical examination. According to Kitson et al (2013), the relationship between health professional and patient is a core theme of patient-centred care. Basing this relationship on humanising values can help to balance the reductionist application of the biomedical model with the human dimensions of ill-health and healing (Galvin and Todres, 2013).

Bronwyn and the nurse

Nurses working in healthcare settings often experience a dichotomy between the humanistic and holistic ideals taught in the classroom and the realities of practice, where the overarching concern is on achieving physical aspects of care (Mackintosh, 2006). In this scenario, the nurse rejected the notion of prioritising care according to physical need and instead saw Bronwyn as a person in distress, recognising her uniqueness. She gave her the time and space to express her feelings in a safe environment, giving her a sense of place. The risk she took in offering Bronwyn this time was potentially not being able to do all her clinical tasks in the allocated time.

Can the HVF help people to do the right thing?

According to West et al (2005) nurses are aware of deficits in standards of care relating to addressing patients’ anxieties and fears, and know these are often due to lack of time and control over the organisational and spatial structure of the caring environment. Patient-centred care is synonymous with improved quality of care but the challenge health professionals face is how patient-centred and humanised care can be identified, measured and evaluated as a quality indicator (Groene, 2011). According to Galvin and Todres (2013), returning to the elements of understanding what it is to be human by exploring humanising dimensions offers a base and foundation from which to begin this journey.

One outcome of the Francis (2013) and associated reports has been to increase the profile of nursing in the eyes of political and NHS leaders. Perhaps this challenging time provides a window of opportunity for the profession to demonstrate its value in championing humanised care as the priority over meeting targets.

Key points

  • Most nurses are committed to providing person-centred care
  • Seeing care through the recipient’s eyes is the foundation of humanised care
  • Our personal values guide our attitudes and behaviour
  • The healthcare system must enable practitioners to practise according to their values
  • The humanising values framework can be used to support health professionals to “do the right thing”
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