Other people's views - working with patients who are 'different' from ourselves

George Galloway finally seems to have lost the plot in his recent statements regarding rape. This blog post is not really about what he has to say, except to say that I am personally outraged by what he (and similar others) have been saying. It is hurtful and offensive. These feelings set me thinking about what happens when we work with patients who hold different views from ourselves - on issues that are fundamental to the way we see the world. How do we work with our student nurses to enable them to deal with the tension that can sometimes exist when we have to hear and experience the views of others that sit uncomfortably with our own world views? For me this issue relates to the focus on caring and compassion that I have had running through many of my postings. My perspective is that it is possible to offer compassionate care even in circumstances that are personally challenging. The education of nurses involves the development of self-awareness, interpersonal skills, awareness of others and their needs, and a real focus on person-centredness. Delivering compassionate care can be learned in my opinion - I think that as long as the nurse has the fundamental characteristics required for compassionate care, the skills required for the enactment of that compassion can be learned. We need to help our students understand that patients have many views, characteristics and values - and each person is a complex mix. So, even though I cannot bear the thought of George Galloway today, I know that I could deliver compassionate care to him if I needed to.

Willis Commission - impact for education

A brief blog as I am just back from Nice and settling back into a different mode of being..... Was interested and very encouraged to see that degree nurses are not 'too posh to wash'. In other words, enhancing the education of nursing students does not appear to compromise their ability to be compassionate. It's my usual soapbox but I (and many of my colleagues who I discuss this with) know this. However, it is great that these early findings seem to bear out what many of us have been saying - that we need to ensure that our nursing workforce are highly educated. Of course, we must all place an emphasis on person-centred compassionate care as we work with our students in the university and in practice.

Understanding others

I have just finished reading The Sense of an Ending by Julian Barnes (which won the Man Booker prize in 2011). It's a bit tenuous to link my leisure reading into a professional blog but I thought I would give it a try anyway! It is a short book - a novella that took me a few hours to read - but (uncommonly for me) I went straight back to page 1 on completing it. I found it impacted on me in a way that doesn't often happen by compellingly taking me into one person's story. For those who haven't read the book, it is a story told by a man looking back over his life, acknowledging the tricks that memory can play, but emphasising the impact that one's experiences can have (whether correctly remembered or not) on choices that are then played out over a lifetime. For me, the feeling that the book has left me with is a renewed appreciation of the complexities of seemingly straightforward lives, the hidden depths of people's experiences that may not be obvious to the casual bystander (or the health professional), and the assumptions that we can make about people's motivations and choices in life. We obviously can't do in-depth interviews with our patients to uncover their life experiences, but for me the book highlighted that we need to take time to understand people as best as we can so that we can at least attempt to put ourselves in the shoes of others when caring for them - an impossible task I know. I don't often get to my leisure reading these days, but I must do so more often as good books help me to appreciate and understand people and ideas better.

"What can and should be done about nursing?"

Articles in the Independent newspaper draw attention to the widespread views of the public and some in the nursing profession of the concerns regarding the standards of care. The general view of the author seems to be that things have gone wrong, and that the way in which we educate nursing students plays a large part in the 'glaring deficiencies' in some practice areas. To balance the negativity the author does highlight that there are 'many excellent nurses and many inspirational examples'.

While I am in complete agreement that we must always evaluate practice and offer the highest standards of care, I continue to find it disappointing that so much of the rhetoric surrounding the evident problems is focused on a supposed change in compassion and empathy (in simplistic terms, nurses used to have compassion and empathy, but now they don't). Interesting that one person who was interviewed for one of the pieces suggests that nursing is a 'basic instinct' in some people, and not rocket science. What I have noticed about myself as a nurse, and my students, is that the educational process facilitates the development of core skills and knowledge for practice, and also enables us to develop as people within the professional context. The combination of high-level knowledge and skills required for nursing practice within this current context alongside compassion, caring, empathy, convinces me that university education (properly developed, implemented and evaluated for practice) is the only way that we can drive up standards. When I say 'university education', I am referring to the essential collaborative approach for education - with students, patients, carers, others. Ever the optimist, I remain convinced that most of the people who choose to come into nursing do so for the best reasons, and that we as educators have the tools to facilitate the development of their potential.

Once again I was privileged to sit on the graduation stage yesterday which our students walked across with pride. My own personal tutor group were amongst those completing and I can honestly say that I would have no hesitation in leaving the care of any of my family or friends in their hands. These intelligent, caring, thoughtful and well-developed individuals are a credit to the profession. It is my hope that people like these continue to work hard to impact positively on practice and to help to make the changes where these are required.

Professionalism in nursing

The Nursing and Midwifery Council has been in the headlines this morning with news of its failings. As registrants we have been aware of the issues facing the NMC for some time now, but the news puts the story firmly in the public spotlight. It will be interesting to see how the NMC shapes up as they make changes and interesting to see that already they have withdrawn the NMC professional advice service so as to avoid confusion relating to their role as regulator. From my perspective, it is not good news for the professions to see the NMC in this situation. It is likely that this story will add fuel to the media fire about standards of care with assumptions potentially being made about the state of nursing itself.

I am sure we all want to see nursing's profile raised positively and as educators (in universities and in practice) we work hard with students to provide them with the learning opportunities that will enable them to operate as professional, caring, compassionate and intelligent nurses. As I've said before on my blog, I am really interested in working towards a situation where we are able to select students who have the potential for all these qualities - I am doing a funded project on a related area. I don't want to give the impression that we haven't been selecting the right people - we have in most cases I think. But there is a need for us to hone our decision-making so that we ensure that we continue to drive up standards of care across all the settings in which we operate.

All is quiet....

It's the time of year when the university building is very quiet with most of our students either out in practice or on their summer break. It is a time for reflection and preparation for the new semester where we will welcome our progressing students back, as well as the new students who commence a range of courses here in my institution. As well as these things, the 'summer' period (not sure whether to call it summer this year!) is time for scholarship and research - both work on existing projects as well as time to work up ideas to take forward in the next session for funding bids. Although busy, there is a sense of a 'pause' in overt activity (i.e. running from teaching sessions, to student meetings, to staff meetings, to......) and I was wondering about our degree students with their 45 week academic year (outwith our circle of influence as this is prescribed) - they never get a pause in any sense of the word throughout their three years as far as I can see. Yes, they have annual leave - but for most of them this will probably involve study, work, family care..... We work hard to ensure that we offer students support in all sorts of areas of their lives (through our personal tutor system, central university services etc.), but I do wonder if the unstinting focus on their course (alongside everything else they do) may be detrimental to their experience as a student.

On the receiving end......

I walked the MoonWalk last weekend in Edinburgh and am proud to say that I finished within our target timeframe (under 7 hours - the bottlenecks would not allow us to maintain our 15 minute average). We set out in the rain, and felt our poor old joints stiffening as we approached the 20 mile mark. I spent the last 6 miles wishing that something would happen that would merit the intervention of a paramedic.....but thankfully this was not required (thanks to my new Jack White album for distraction therapy!). However, I woke to a painful foot on Monday. Inter-professional working is alive and kicking in my institution, as my physiotherapy colleagues helpfully provided me with strapping and crutches - and a diagnosis. I was advised to attend my local A and E and now am reflecting on the way in which I reverted to disempowered and compliant patient mode. I apologised for bothering the doctor, did not press when I was given a diagnosis that did not make sense, and left without any discussion about how the wearing of trainers would enable me to weight bear. It was an interesting experience that, for me, sheds some light on the patient experience and what matters. Of course we want to be dealt with by people with the knowledge that ensures that we receive the correct treatment (and usually we take this for granted and rightly so). But if we take 'correct care' as a given, then my priority is compassionate care - even in a situation which is not life and death but one which impacts on my own personal lifestyle and work needs. Education for compassionate care is at the forefront of my thinking at the moment - as health professionals we need to be providing evidence-based care within a compassionate framework of working practice. We are grappling with this every day as we work with our students to enable them to become the best they can be.