I am never stuck for a blog subject – in fact, sometimes it can be difficult to choose between competing possibilities. And today is no exception. Do I write about the shambles surrounding the miscommunication of the recent pay award? Do I write about Gosport and the way that an awful lot of nurses thought it was OK to say (and do) nothing whilst inappropriate medication regimes were prescribed? Do I write about the issues facing the nursing regulator? So many blogs, so little time. Last time I wrote about nostalgia and the dangers of thinking that the past is a better place. And I am minded to continue that theme today because this morning something happened that compellingly illustrated the meaning behind my last blog – that ‘nostalgia is a seductive liar’.
Whenever I, and others, talk about what we call ‘modern nursing’ i.e. evidence-based interventions, Bachelors degree entry-level, autonomous practice, acceptance of accountability, being patient-centric, professionalism with a big P etc. there is an instant response from far too many people (including nurses), denying the need for all this unnecessary over-thinking and calling for a return to the days when ‘nurses did the real work at the bedside and patients were properly cared for’. It has become depressingly familiar. The rose-tinted specs go on, the self-preservation and lack of insight appears, and those who defend their own level of training/education as the best there has ever been promote their vision of the past as a credible way to handle the future. Sadly, some of this even finds its way into policy making. As I said, it’s depressing.
So, this morning when the video below appeared on my Twitter feed, shared by Liz Anderson who tweets @nutritionlizA, I thought it might illustrate some points, although I wonder how many of those who need to read this blog, will actually see it. I suspect I am preaching to the converted.
I have first hand experience of this sort of nursing. I spent many hours as a student nurse in the early seventies working with Staff Nurses and doing exactly this. In elderly care environments and also in more acute environments, the principles were often the same – get the jobs done. And when you watch you can see that there is care here – these patients are bathed, and dressed and undressed. They are positioned in bed and turned. Their hair is combed, their bed linen is fresh. Their environment is clean and tidy. I can hear some people saying ‘Yes, and that’s how we need to be now. Those patients were really cared for’.
And look at the nurses. Busy and purposeful. Tidy and their rank obvious. Brisk. Getting the job done. All patients washed, clean, tidy and neatly in bed. All boxes ticked. ‘All care given’ – remember that? Written in the Kardex? ‘All care given’.
But, oh, those women. Naked in a public place. Covered as an afterthought by a towel. In bed though it is broad daylight. Tucked up and tidy with covers right up to their chin. No conversation. No information. No choices. No distraction. No entertainment. No interaction. No interest. And look at their empty faces, the weary eyes, the resignation, the waiting, the sadness.
I know that this is not how we expect things to be now. We have moved far away from the rote completion of tasks and those in our care are treated as individuals with all the involvement and interaction and choices that means. Getting the jobs done is not at the heart of our care any more, is it? Seeing the individual, understanding what those facial expressions or that body language and those clinical signs mean, and responding to them appropriately and thoughtfully, drawing on our education and experience to make changes, to tailor interventions, to improve lives – these are the actions we would expect now. How differently those women could expect to be treated, nursed, today.
The difference, the biggest, most obvious difference in my opinion, between the nurses in that video and today’s nurses – is in the education of Registered Nurses. Rigorous academic teaching of the developments in nursing and in medicine, a greater understanding of the elements that help to keep people in our care happy, healthy and safe and comfortable, and the clever translation of that into appropriate intervention. A complete change of approach from ‘getting the tasks done’ – the baths, the rounds, the teeth, the hospital corners and the turned under counterpane (a signal action of the 1970s nurse) – to seeing the whole person and understanding what is going on in their bodies, and their minds, and how we can help them. Having the intellectual capacity and intellectual training to be able to access a huge knowledge base, sift what is best in any given situation based on the evidence, and apply it confidently and with exquisite individual finesse. It has been a transformation. Mostly.
It makes me very nervous when I see shifts in the way that care is led and organised that seem to promote the task above the knowledge; the ‘basket of skills’ rather than a depth of education that enables the intervention to be chosen and tailored, modified and improved upon. It reminds me of these times. In this video the tasks were done. The jobs completed. I’m sure any checklists were filled in. But it looked pretty grim to me. Valuing the rote performance of task is backward and dangerous. And it is still around us. There are places where the thinking (or lack thereof) of some can be frighteningly similar to that video. I blogged about my experience of the same sort of thing in a different context during my mother’s last weeks in a hospital, just two years ago.
I cried when I watched that video. I cried for those women, and for the ignorance of the past. What makes the difference between that video and today? Education and the application of knowledge in every moment of practice. The valuing of education as the route to excellence and safety in care. Let’s not start forgetting it now, for pity’s sake.