Are we lacking compassion?

A paper from the NHS confederation has drawn  my attention to the common, human decency shown to people who we come across during the course of our work. During a time when we are obsessed with medical treatments, having the best drug, the most high tech investigation. When league tables concentrate on cleanliness, waiting times and other Key Performance Indicators (the favorite phrase of the commissioner these days) what happens to the more subtle, difficult to measure things. Human caring and compassion has always been a quality people assume those working in healthcare have in abundance, but do they? As often is the case it takes a medical person encountering the front end of medicine from the sharp end (ie through one of their close family) to make us take stock.

Robin Youngson is an Anaesthetist in New Zealand whose 18 year old daughter was forced to spend 3 months in hospital immobilised with a broken neck. While her the level of the actual medical and nursing care received was without fault, he was struck by the lack of care and compassion shown to his daughter. There were no systems in place to enable a (thankfully temporarily) disabled teenager eat, watch tv, read and get through the enforced period of hospitalisation. Robin speaks of having to plead with staff to ensure that his daughters most basic social and emotional needs were met, of spending a large amount of money on car park charges, of finding that nurses and doctors exibiting compassion were in the minority rather than the majority. Robin suggests the following action plan is required:

Declare compassion as a core value

Reward rather than punish compassionate caring

Hone communication and relationship skills

Provide space for staff to discuss difficult issues

Challenge models of professionalism

Hard wire new behaviours

Declare compassion as a management and leadership competence

Engage health consumers in the change

you can read the whole article here. You can join the debate here What is clear to me is that there is more to good care than a clean hospital, the best drug and the shortest possible wait for treatment, rather those of us who are in the business of providing healthcare need to sit up and take notice. Human skills of caring and compassion have nothing to do with role and status but should be a basic requirement.

Unique selling point?

In these days of a health care system that is increasingly orientated to the world of business, then perhaps we all need to be indentifying our unique selling point. Services, including those which deliver care to patients are increasingly subject to competition, they need to be cost effective, evidence based and all of that important stuff. We might not like the way this is heading, but actually there are some positives, it means that services are starting to run according to what patients need rather than what health care staff think they would like to provide. There will in the future be less possibility that a service could be offered on the basis of a whim of one or two individuals. So as a nurse what skills might I have that no one else does. If doctors can apparently be replaced by nurse practitioners / nurse specialists / nurse consultants then we as nurses can also be replaced by a cheaper or as some would say dumbed down version.

A post by The Shrink over at Lake Cocytus about communication skills got me thinking. As is often in the world of the blog, he got the idea for his post from a medical student, this is one of the great things about this kind of media in my view. As a student nurse my very first experience with people on a hospital ward was not to take a temperature or blood pressure, it was not to do a dressing, no we were instructed to sit at people’s bedsides and talk to them. This was really hard. We were the most novice of nursing students, we had a uniform but we had no actual task to perform. But that day stays with me, and now that I reflect on it, I would be as bold as to say that it has helped to make me into the  nurse I became and the person I have become. Communication isn’t just about speaking, it is about being able to give time, to meet a person’s eyes, to wait while they take in and digest a difficult piece of news. It is about being able to pick up those non verbal cues, it is about being able to sign post the patient to the right person and about being able to point the doctor for example to the problem as experienced by a patient.

A patient was admitted with anaemia, can’t remember the underlying problem (it was a few years ago). I admitted the patient, filled out his paperwork, did his obs. He reported that he was a Jehovah’s Witness. I knew some of what this meant, but said little at this point. The doctor saw the patient and came back to the nurses station and wrote up a blood transfusion. I asked the doctor if he had discussed this with the patient? He said yes he had mentioned it. I suspected that he had told the patient what was to happen and the patient might not have understood what was was meant by it. I approached the patient and sat and had a conversation with him about the treatment proposed by the doctor. Not surprisingly he was not prepared to entertain the blood transfusion, but did want to be treated and didn’t want to seem difficult. Nothing I did was better than the doctor on that day, it was just different. I had the benefit of having admitted the patient, but also that our admission process asked questions that encouraged the patient to tell things from their point of view.

When as nurses we think we would like to more exciting things, to diagnose and to prescribe we need to remember the essence of what a nurse is. By all means learn new knowledge, develop new skills. But will the patient benefit and in what way? Will you be applying your new skills plus using the ones you developed in nursing school? Will you still have the time for those high level communication skills? Will you be able to pick up the non verbals? I have been a specialist nurse, I have taken on skills that average nurses do not perform but at the heart of what I have always done has been that special thing that a nurse is best at – communicating with the patient, identifying what the patient thinks and what the patient feels rather than what we think they should think and feel.

I might not work at the bedside in my current job, but actually I use those skills every day. They are what makes me able to say even to this day; I am a nurse and proud to be one.

Its not always the things that we say that is important…

But the way that we say them. Two things this week have prompted me to think about the things that are said and the way in which they are said and the importance of how they are interpreted by others. Last night I was watching a UK hospital drama, well more like a soap seeing as it seems to be on all the time. I don’t think it portrays hospital life exactly as it is, well I know it doesn’t, but haven’t worked on a hospital ward for so long that it is best I don’t make any assumptions. A very unpleasant patient and his family were portrayed on last nights episode (now as we know not everyone is nice so it is possible that sick people can be unpleasant), and during heated conversations he told the black female doctor that he preferred to see the organ grinder not the monkey. Now this was meant and taken as a racist comment, but it can also be used as just a derogatory comment used in anger, I know this because a patient once used it on me.

As a specialist nurse I worked in clinic with the consultant. Patients were booked in to see me, usually to start on new medication, discuss progress with their condition and the like. They were always able, at the very least to have their cased discussed on the spot with the consultant and often to see him if necessary. On the day in question a man with recently diagnosed rheumatoid arthritis arrived to see me to start on new medication having seen the consultant a week or two before. He walked, or limped in, sat down. I began to ask him about his symptoms and talk about the proposed medication and in response he looked me up and down and said, hmm well, actually I would prefer to see the organ grinder and not the monkey. A little stung, but keeping my composure I told him that I would go and speak to the consultant right now and left the room.

The consultant was incensed and marched down the corridor to the consulting room and told the patient in no uncertain terms that he would not accept that kind of behaviour, that I was very experienced, but that I always consulted with him. Then calming down he examined the patient who had a particularly swollen and painful knee. A stroke of luck then ensued, because he said, well we need to get you on these new tablets and Julie will go through them now, but also you need your knee aspirating and injecting and Julie is fully qualifed to do this for you. When the man returned 6 weeks later for a follow up he was full of praise for me and from then he often came to my clinics, and never grudgingly.

The second incident is completely different but if anything more disturbing. Apparently if you are applying to adopt a second child in an area near to here, then it would be best if you called your first child’s real mother their ‘tummy mummy’ and not birth mother. Because if you are using the wrong terminology then it may put the process in jeopardy. Never mind that you are making a pretty good job of bringing your 4 year old up and that child is happy and well adjusted. Some social workers still seem to like the power they have and that is all I will say about it.