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Practice Comment

'Caring is a fundamental part of the job, not an optional extra'


My father was in hospital after having had a severe stroke.

As I entered the ward for the first time, I saw a poster on the wall advertising “Making Time to Care”, which had been created by someone with the title of dignity nurse. The poster featured a number of ideas on how a busy nurse could create space in a busy schedule.

I was incredulous. I imagined boarding an aircraft to be faced by a poster with suggestions for the pilot about “Making Time to Concentrate”. I also envisaged entering my daughter’s school to see a poster advising people on how teachers might “Take the Time to Educate”. If I went into my bank and saw a poster suggesting ways in which the staff might “Make Time to Get the Sums Right” I would promptly close my account.

The essential element of a pilot’s role is concentration, a teacher is an educator and a bank has to demonstrate that it will not lose my money. These are not optional extras in an otherwise busy day, they are key functions. A nurse’s role is surely about caring? It must be the central task and not something to be done in bits of time that can be freed up.

The care my father received was good in so many ways and yet I arrived on the ward to find him lying naked on his bed in full view of others. This must have been humiliating for a dignified man. He was being called by the wrong name despite the fact that his notes made it clear what he preferred to be called. His Parkinson’s medication was changed - as a result of which his shakes became uncontrollable - and it took the threat of a complaint before his long-established medication was reinstated. His cards and photographs went missing.

None of these things was really a matter of time. Drawing the curtains takes seconds. Presumably the notes had been read but it had not registered with the nurses what he preferred to be called. I discovered that the change in medication had been a matter of cost to the hospital.

Whoever moved the photographs and cards did not care enough to remember to return them. None of these issues is really about time - each one comes down to mindfulness. They are about caring sufficiently to make sure that the things that probably mattered to him most were done.

My father did, however, have a lot of things done to him - things that he grew to dread and things that all the members of our family (he included) knew to be futile. The things done to him appeared to be the priority. His care seemed to epitomise task orientation at the expense of caring.

There appears to have been a flurry of recent reports of neglect and abuse being carried out by nurses in all specialties. The extreme cases illustrate an extreme lack of caring. Examples such as the one I’ve described here demonstrate a subtler lack of care, no matter how well-intentioned the nurses were. How do we put caring back at the centre of training and practice? Can we relocate “tasks” to a position of lower priority? NT

Steve Mee is senior lecturer, Faculty of Health and Well Being, University of Cumbria

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Readers' comments (22)

  • you put caring back into nursing by employing nurses who care, by taking on students who care, you don't need a degree or formal qualifications to be a caring and compassionate person.

    open up student training for people who will be good at the job and who want to look after others.

    let's not have another degree nurse argument - just employ and train the right people.

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  • anon 6.31 - agree with everything you have said. nursing has really hit rock-bottom and things have to change. if this means going back to a non-academic course then great, let's not worry about anyone having to save face or having to justify their decisions - nursing is about looking after people, nothing more nothing less.

    looking after people can be at ward level or it can be at research level, it doesn't matter - nurses all have different skills and different interests but you have to start at the beginning - if you don't care then don't work in health.

    HCAs and student nurses should only be employed because they genuinley want to improve things for their patients.

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  • tinkerbell

    Anonymous | 29-Nov-2012 6:31 pm

    there are plenty of caring people in society without academic qualifications otherwise we would all be done for.

    I think a vital question that should be asked is 'why do you want to become a nurse?' In the answer somewhere should always be a desire to 'help others'.

    Unfortunately if nurses are left short of staff they can mostly only cope and coping is not the same as caring.

    Give us the tools and the majority of us will do the job.

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  • michael stone

    Steve has explained the things patients and relatives frequently see, and are upset by, very eloquently.

    It appears that some hospital managers, and some nurses and doctors, do not see these problems.

    As Steve says, it isn't solely down to pressure of time - but some of it might be a gradual erosion of 'the caring mindset' that results from working in an enviroment where nurses often have more tasks to complete than time to complete them in, over many years ?

    Although, of course, it is more complicated than 'just one thing'.

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  • I believe most of us come into nursing with the right caring attitude but have little control over the way we work. It's the staffing, leadership and organisation culture that influence what we prioritise. All I can do is try my best to treat people with care and respect as I run around like a headless chicken trying to keep them alive 1st and my job 2nd.

    While Steve has a very good point about general mindfulness, he is clearly very out of touch with the realities of nursing on most wards in most hospitals in the uk. e.g. 1 nurse to 8+ patients and senior nurses who offer no clinical support but keep ramping up the pressure.

    On the point of patient's exposing themselves, and lets be clear that is how it happens. I have never seen a nurse or HCA walk past a patient exposing themselves and not attempt to cover them in some way (curtains may not be appropriate as patient is the not visible). I have however seen a matron observe this and then look for the nurse to berate them about it instead of covering the patient first.

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  • A year ago I was a patient in a hospital in Swansea- there was another patient who had dementia who like to wander around the various bays. He was berated and hustled numerous times back to his bed, told to sit down and stay there. He became even more confused over a few days and then started to remove his clothing- again raised voices! He then stripped completely and wandered- the nurses took him back to his bed and dressed him, and then got bored- until eventually one busy morning- he walked to the nurses station naked and sat on the floor. The sister (!!) said to leave him there he would move when he got cold and told the cleaner to put a 'caution wet floor' sign at his feet and his head. He stayed there for a long while until I went out to the nurses station and demanded the nurses did some thing. This happened at least three times whilst I was a patient on that ward.
    Not one nurse stood up for that man, and after I asked for something to be done- they called for security to 'haul' (their words) him back to his bed!!!
    I trained in the 70's and have worked in the NHS and private sector as well as abroad; I have never seen such total lack of care, the 'C' word that nurses do'nt use anymore.

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  • I cannot belive that a patient can be treated like this. This ward and staff sound like another Winterbourne Veiw and they deserve to have action taken against them. Do they think they working in a concentration camp?
    I would like to think that you wrote a major complaint to the Matron/Director of nursing when you were well and out of hospital.
    Where has kindness and care gone to never mind the academiic qualifications.

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  • Anonymous | 2-Dec-2012 7:15 pm

    i was shocked to read your expierence. Can not believe that happened ( well i can) I too would have complaint.

    I know i was in charge once years ago on a ward and saw a soiled pad on the floor i observed for ten minutes, staff kept walking passed it in the end I did pick it up and dispoed of it, but i was surprised that other staff just ignored it. ( i was trying to see if anyone else had noticed it but obviously not)

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  • The Happiness Purpose by Ed. de Bono is a very helpful read in discovering ways of dealing with and more effectively managing your own personal 'self and coping space', that of others and the surrounding demand space which can be a major cause of stress and its consequences. Demands can be self imposed or forced by others and the environment such as expectations and goals which are too high. It also deals with the ego and detrimental effects of the over-inflated ego.

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  • The incidents and issues described above are very real and very shocking. I cannot agree more that something needs to be done but I'd like to reflect on two of the comments above....

    " don't need a degree or formal qualifications to be a caring and compassionate person..."

    "...let's not worry about anyone having to save face or having to justify their decisions - nursing is about looking after people, nothing more nothing less..."

    ...I mostly agree with both of those comments. However, if you think about it both of these imply a complete end to the nursing profession. If you don't need formal qualifications you don't need nurse training either. If you don't need to justify your decisions how can you be held to account? We hear the phrase '..too posh to wash..' a little too often but perhaps it captures a sense that for some nurses the fundamentals are beneath them? Are we also saying that you can be too clever to care? Nursing can't just be about caring - it has to be about caring + something else - knowledge, skills expertise and judgement. Crucially its about bringing those things together into the whole package. When I go to hospital or visit my practice nurse I want the nurse to be nice to me but that is not all i want/ If I just wanted people to be nice I'd go to my local corner shop where tea and sympathy are on offer in abundance. And when a nurse makes a decision that might affect my future health and well being I want to be very sure that they can justify it.... This is not about degree or not but it is about training and educating nurses properly and to a high standard. Like it or not this involves intellectual work that draws on and builds on basic education maths, english, biology, psychology and much much more....

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