Nursing Times Award Winner

Why nurses shouldn't need to be taught compassionate care

The vast majority of people who enter the nursing profession do so brimming with great intentions of delivering the best possible care to patients. They shouldn’t need to be taught compassion. They come into it with shedloads of it, fired up from the first day of their training to be the best nurse ever.

But, often, soon after their first placement on a ward, things start to go wrong. Intent on offering the best possible care, they soon realize that the system can be stacked against them. Endless targets, fear of litigation, lengthy paperwork, the constant sound of a buzzer from people trying to get into their ward that is, often, needlessly locked, all interrupt their desire to give the individual care their patients deserve. This makes them feel harassed, unappreciated and devalued.

All of us feel huge frustration and anger when we fail and it’s not our fault. The disastrous job interview, the exam where the wrong questions were asked, the lost document you thought you’d saved on the computer, the printer, despite being full of paper and ink, that still won’t print.

So, imagine you chose nursing as a vocation and then, day after day, had to see your profession damned in the papers. Wouldn’t you feel totally demoralized? Many are so depressed they leave. Many stay, but only because they worry about finding another job. Tragically, few would advice their career choice to their children. It’s a dangerously vicious circle.

I work from home. Last week I had an appointment. My daughter was in her bedroom revising for an exam. Thinking she’d appreciate the chance to earn some easy money, I asked her to answer the office phone while I was out. When I returned at lunchtime, I asked for the messages. She gave me four and then told me the rest were on the answerphone. She could see I was shocked that she had abandoned such a simple task to a machine.

Then she explained.

The phone had rung all morning, constantly interrupting her revision. She needed to concentrate to pass her exams. So, in order to give herself the best possible chance of passing, she had shut her door and let the answerphone do the work.

And that’s the dilemma nurses face every day. They have to do so many tasks that constantly take them away from the bedside, that they not only fail the patient, they fail themselves. The vast majority set out to do a good job but feel, constantly that the odds are stacked against them. So, when criticized, either personally as or as a profession, many become bitter and very angry and that, of course, impacts on the patients they are trying to help. When they, or their relatives complain, the staff are defensive. Very quickly things go from bad to worse…much worse

Day on day, people pontificate about patient care. Patients have to be safe, Patients deserve compassionate care. There are not enough nurses. Everyone writes about the problem, reports when things go wrong, but what is the solution? You can teach people how to deliver compassionate care, but many are insulted by the process. They know what they have to do, they are simply not given the right environment to deliver it.

A huge part of answer is more staff. But cutbacks make it impossible to give the levels required. So, what can be done?

Kissing it Better believes part the solution lies in the community. Young people, desperately in need of specific work experience who, under the strict supervision of their tutors, can use their specialised skills to complement the nursing care offered to patients and their relatives.

We invite students from universities, Further Education Colleges and schools to do parts of their course in hospitals and care homes, mainly with older people. So, beauty therapy students offer simple treatments by the bedside, music students sing or play instrumentals either as soloists or small groups, drama students read by the bedside or perform short familiar plays. The list is endless. The patients benefit not just from their wonderful skills but also from the time they have to chat to them afterwards. The students gain invaluable work experience in an, often, challenging environment and that enhances their life skills and, through that, their employability. It’s a win/win.

But there are other, more subtle benefits too. With their bright chatter, their fun clothes and great smiles, they bring the outside world into an institution full of uniforms and strict regimes. Patients feel more in touch with their community. The students ‘spark everyone up’. Staff enjoy the fun and, like the patients and their visitors, are energised by the experience. And when that happens, care improves.

It’s not rocket science. Through this initiative, thousands of students across the country are now making a huge difference to how patients feel about their care. Wherever they work, complaints are reduced and morale is raised. Staff respond to the lightened atmosphere. Patients who are entertained are easier to look after. They take a greater interest in their surroundings, are more inclined to move and to eat and drink. Their recovery is faster.

Whenever we are feeling down, most of us appreciate the friends who comes to cheer us up. We behave better and slowly we get our life back into perspective. We may not have felt able to actively seek their support, but when it is freely offered, it can be hugely welcome and highly beneficial.

In days gone by, without modern medicines or sophisticated equipment, people relied on each other to see them through difficult times. Nowadays, all too often, we turn to tablets or professionals when we need help. We call it progress but I’m not sure that’s right. It’s too easy to suggest to someone that they need help without first thinking what you can do to make a difference.

Finally, here is a simple analogy.

NURSING AND THE FRAUGHT MOTHER

Imagine the new student nurse is like a new mother, who gazes lovingly at her new-born baby and wants, with all her heart, to be the best mother in the world.

Then move on five years when that same mother now has three children. It’s winter, it’s cold and it’s raining. The five year old, for the moment is well and running around the house. The three year old has an ear infection and the baby has a tummy bug.

The five year old wants to go to the swings but the mother is up to her neck in vomit, diarrhoea and an untidy flat. She hasn’t slept all night and the baby won’t stop crying. She tells the five year old that they will go to the swings but he will have to wait. Battling dirty nappies and clothes covered in ‘sick’, the mother is also worried about the unpaid bills since she gave up work, and is hounded by a neighbour who keeps threatening to complain to the landlord if she doesn’t keep the noise down.

She wants to be a good mother and, more than anything, she wants to get to the swings so that she can give her beloved five year old the treat he deserves. But the odds are stacked against her. She doesn’t have enough help, her money worries are making her anxious and the lady in the flat next door keeps banging on the wall threatening her with eviction if she doesn’t stick to the rules about reasonable noise.

When six o’clock comes, she hasn’t got to the swings. By now she has shouted at the five year old for asking for what she cannot deliver. Yet he was the person she most wanted to help, the person she most wanted to believe that she was the best mother in the world.

But, in the end, the odds were stacked against her and as night falls, they are all in tears. In some truly desperate cases, a mother in that situation may resort to harming the very child who most needs her love.

That mother represents many of the thousands of nurses on understaffed units, the unpaid bills represent the hospital that is battling limited resources and the lady threatening to report her is the Government imposing a string of impossible targets.

Relief only comes to that mother the following day when a friend calls round with her children. In theory this will mean extra work as the friend will want a coffee and her child will only add to the mess and the noise.

But it doesn’t work like that. Coming in from the outside world, the visit calms the situation. The mother behaves better now that she has a visitor and the children, sensing their mother’s more relaxed mood, calm down and are delighted that a child has come to play. The friend feeds the toddler and then suggests she takes the older children to the swings. Now everyone is happy.

That friend represents help from wider the community. She doesn’t come with any particularly specialized skills other than common sense. The fraught mum not only appreciates her company, she is also touched that anyone would want to give up their time to visit her when her life was in such crisis.

Kissing it Better passionately believes that the talent, ideas, energy and commitment of vibrant organisations in the community, supervised with the intelligence, enthusiasm and gratitude of NHS staff, can go a long way to lifting the spirits of those working, and being cared for within a hospital.

We also believe that the simplest ideas can make the greatest difference.

‘Everyone is totally ‘sparked up’

A grateful relative’s comments following a visit by beauty therapists, a children’s choir and therapy dogs to an elderly care ward at The Lister Hospital, Stevenage.

See BBC BREAKFAST FILM OF OUR WORK

http://www.bbc.co.uk/news/health-20807641

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