By a process called psychological continuity, John Locke reasoned that personal identity is bound only to consciousness.
At any given moment, we are the thoughts that occupy our minds and the memories contained within them. As we grow, experience, learn and forget, our identities are fluid and changeable.
As a profession, how often do we truly embrace our patients for who they are in the moment? How often are we guilty of making small judgements about the person before us for the choices that may have led them to our door?
My last clinical placement was based within a community alcohol and drug service.
Every day I met people who found themselves in positions that many, at a glance, would consider difficult to relate to. So difficult, in fact, that substance misusers remain some of the most maligned members of society; people we might actively resist relating to.
Addiction is socially relegated to the realms of character weakness, poor morals and the criminally minded, with few stopping to ask how or why.
Without a ‘come as you are’ approach, substance misuse services would face a theoretical paradox. If a person can only access the service while always being in control of when they use drugs or alcohol, the service would not be needed.
However, addiction nursing is taking this one step further, by fully embracing those with active addictions in each moment, without judgement (no matter their past) and most surprisingly, without any expectation of recovery.
“Accepting people as they are releases service users and nurses from the service-focused pressures that form barriers”
Although it may be difficult to imagine, the concept is based in strong evidence surrounding the concept of harm reduction.
By moving away from an abstinence-focused model of care, nurses are better able to address the many harms substance misusers face. Even if that is as simple as someone smoking heroin rather than injecting; it isn’t a cure but it dramatically cuts the risk of overdose or contracting a blood-borne virus.
It’s the middle ground between all or nothing, where people can finally begin to breathe.
Accepting people as they are releases service users and nurses from the service-focused pressures that form barriers to building effective therapeutic relationships.
And it makes space for change, rather than trapping people in cycles of failure. If we expect too much of people, we make change seem unachievable and risk alienating the people who need us.
Most importantly, when we accept people as they are we are often given an insight into the stories behind the risk behaviours. In substance misuse, we see the traumas that people are typically self-medicating. We see the person.
“As a profession, we must continually ask ourselves – who does this benefit?”
In the broader context of nursing, when we judge the health risk behaviours of the obese, smokers and others with the singular focus of curing people, we miss an opportunity to connect with them and to create a space in which they can make small, manageable changes.
As a profession, we must continually ask ourselves – who does this benefit? We must let go of service-focused outcomes. As the NHS continues to struggle, we cannot afford to alienate people only for them to become sicker.
Having walked alongside people in some of their darker moments, it strikes me that suffering is easier to see if we are conscious and present with the people we are privileged to care for. If we retain our humility, it is harder to judge even the gravest of mistakes.
Leanne Patrick is a second year student mental health nurse at the University of Stirling