What stops care?
I started my nursing career in Edinburgh, mostly within the historic buildings of the then Royal Infirmary of Edinburgh. Its roots were as a charitable hospital and as such was proud and confident of its superiority.The Nightingale wards offered a really great opportunity to monitor patients but little opportunity for patients to sleep.
The wards were the domain of the Sister (yes sexism was alive and well) and the hospital the nurse managers (even the matron had met her demise-Hattie Jakes had hung up her starched cap). You knew where you stood and frankly as a student nurse that was in a pretty shaky position. You did a lot of learning by doing (yes ,thrown in the deep end ) and team dynamics and local leadership were the things that helped you sink or swim. The good old days? I do recall being reprimanded for talking to patients and sent to clean the trays instead…mmmm. And in other wards my memory even now is the love and compassion shown to others and how proud I was to be part of that. It’s the difference leadership makes ,you see.
Recently this august organisation has come in for some tough criticism. It’s not the environment that’s the challenge now( car parking charges apart)-it’s a state of the art new hospital-it’s the level of care. It’s the milk of human kindness. And we know from reports in other care settings, this is not a challenge peculiar to this hospital. What has caused this shift-if indeed it is a shift?
Some have suggested that its now that nurses have degrees, the compassion has gone. Do we really believe that people cannot have advanced level education and be compassionate? Now I speak as a former nurse with a master’s degree so of course I am biased. When I did my degree in nursing more than 30 years ago now, we were a rare beast. Patients often asked why we wore a different dress. “Its because I am doing a degree along with my nurse training”, I replied on one memorable occasion. “What degree is it?” he asked. A BSC said I."What does that stand for?" (I had had a particularly trying day) , “Best S**t Cleaner” said I-engaging my mouth before my brain. How we laughed…phew! But what did my degree teach me? It focused on person centredness, it taught me that health is much more than biology; it enhanced my people skills and so much more. It also taught me to question and not to accept anything less than the best. And its why I am still focused on these things now
Maybe we have focused on the wrong outcomes over time. Improving clinical outcomes is of course a priority but perhaps in some settings that has been done at the expense of patient experience? Have we lost the clarity of leadership in the complexity of management systems and in turn the leaders finding themselves focused on targets rather than people? No doubt its complex and no one solution can fix it, but fix it we must.
In an attempt to redress the balance the Scottish Government have put a key focus on person centred care. And that is welcome. And there are a number of approaches to help services to get to the heart of the issues. Breakthrough Breast Cancer introduced the service pledge a number of years ago and it does that very thing of getting to the heart of the issue, providing patient feedback and patient support to improve person centred care. Another such tool is emotional touch points giving patients the opportunity to express their feelings and enabling staff to access emotional language through that process. Both mechanisms are empowering to staff and offer patients a way to move on in their recovery. The stuff change is made of. So it can happen, we now need a will to change and also I believe to acknowledge a key role of the third sector too to enable that as partners in the process.