A contribution to 2020health’s recent report ‘Too posh to wash? Reflections on the future of nursing’
By Julia Manning, Chief Executive, 2020health
It has been concluded by some anthropologists that evidence of civilisation is not when man-made tools are first found, but when healed bone fractures are discovered. For a facture to have healed indicates that this human being was fed and cared for until they had recovered.
Life is about caring relationships. We are defined by them – mother, son, aunt, grandfather, partner, boss, carer etc. It is in our relationships that we are first cared for and in which we first have the chance to learn and value what caring for others means too: compassion, comfort, sympathy, kindness, listening etc. Relationships are our greatest test and can be the greatest source of happiness. Developing the emotional intelligence to handle, extend and appreciate our relationships with family, friends, and work colleagues is vital to our wellbeing. How much we value each other and what that means in practice in terms of time, gifts, affirmation, touch and kindness is a bellweather of a healthy society. So it would be remiss to simply look at one sector, be it nursing, management or any other, and critique it without reflecting on what is happening more widely in society.
We live in a world where technology means we don’t have to be out of contact, ever, yet there are (at least) two major societal trends which are undermining the value of caring relationships. Without thinking these through we will only ever be sticking plasters of platitudes on the recurring wounds of those who have not been cared for, or left to console on another occasion in the future the families have been scarred by the lack of care.
The first trend that undermines caring is materialism. We have become a society that gives priority to things over persons. We know the price of everything and the value of nothing, and people who are frail and elderly are seen as a biological losers, not producers or net contributors to society. Whilst caring for someone who will get better and be able to contribute is seen as valuable, caring for someone who is confused or dying is regarded as pointless. There is no material gain.
We have heard a huge amount about dignity in the press, but all too often it is being related to independence. It seems to me that dignity is being confused with autonomy. True dignity is intrinsic, it is bestowed – how we are treated, loved and nourished as human beings – not dictated by how we look, what we own, what we can do or say or feel. This kicks against the zeitgeist: that we are supposed to be in control, able to choose our destiny, acquiring and consuming the indicators of our worth. Whilst young people grow up thinking that designer trainers are more important than eating, we can’t expect them to value very highly caring for others. 2020health recently supported a cross-party inquiry into unplanned pregnancy. Part of our research revealed the longing amongst young people to have the chance to talk about relationships. They were not wanting to talk about the biology, but about emotional resilience, confidence, self-worth and negotiating skills they realised that they lacked. Life skills that were once acquired in the home are being neglected. And the second trend is one of the key reasons why.
Technology is a tool, not a panacea, it doesn’t transcend the need for caring. Whilst technology has given us amazing opportunities to remain in contact 24/7, simultaneously with this opportunity for connectedness has come a parallel escalation of isolation, loneliness and loss of social skills. If society means a unified group of people who are like-minded, collaborate and share real experiences, with our ever increasing modes of ‘socialising’ we have become less and less an actual society. Several older people have said to me recently that ‘the phone doesn’t ring anymore’. The first transformational technology that allowed people to communicate immediately across far distances has gone out of fashion. In our busy lives, a quick text or tweet is supposed to suffice, but for those whose lives are more restful, neither the doorbell or the phone now ring.
As young people grow up they normally learn social skills through observing social exchanges , interacting with their environment and from moral guidance. Often without thinking, technology (in the form of TV, computer games, mobiles) has been allowed to reduce human contact to a level such that children are arriving at school without the necessary social skills or vocabulary for communication, interaction with other children or understanding of covert messages in speech and behaviour. Over time use of text messaging increases, with the concurrent loss of nonverbal communication cues such as tone of voice and body language. Ask any secondary school teacher and they will roll their eyes at the amount of grief caused by miscommunication on social media (let alone the deliberate cyber bullying) outside of school that then spills into the classroom.
A young adult with under-developed social skills is not going to have a learned or intuitive appreciation of how someone else might be feeling, either emotionally or physically. They will have poor relational skills and if combined with the first trait of being materialistic, will not have the emotional intelligence that we expect of an adult.
Someone who doesn’t value people, or even looking after themselves, over things, and who hasn’t learned the importance of good communication is not going to make a good carer, no matter how smart they are. If we are caring less in our personal lives, that will transfer into our public and working lives. We take our values to work – beliefs and worldviews may be personal but never private – they shape our thinking, attitudes and actions. It is also important to acknowledge that there are health professionals who have in abundance the ‘softer’ skills of listening, sympathising, holding someone’s hand, considering someone’s comfort or anxieties, and have been frustrated by a rigid emphasis on efficiency and cost effectiveness. It is difficult for the latter to contain measures of the consequences of good holistic care which could mean quicker recovery, less anxiety and fewer readmissions.
So in thinking about the nursing profession in this book with the many commendable recommendations and advice, we will only be partially, and maybe temporarily successful in bringing about any improvement in nursing care and reputation if we don’t at the same time take a hard look at the society we have become. Simply to tackle the culture at work is not enough; if we don’t raise the status of caring across society then nothing lasting will be achieved. And that includes caring for children, caring in care homes as well as for the sick in the community. There is an opportunity here for the government, society and the NHS. The financial reality is that we simply can’t afford to employ ever more NHS staff to meet the needs of older people in hospital, who make up two thirds of inpatients with 30% of them having dementia.i The NHS of today has completely different demands upon it compared to sixty years ago, and we have to adapt to this. The cultural reality is that we need to encourage caring – as a common good and as a responsibility.
Many of the distressing stories we hear of inadequate care stem from patients not having help with basic needs such as assisting to the toilet, feeding and drinking. If you have 20 patients all being served lunch at the same time and 15 of them need help with eating, it’s an impossible task. The time has therefore come for relatives and friends to be expected to assist with in-patients, just as they would if that person was still at home. Hospitals should both welcome and require help from the patient’s family, and this should be stipulated in the NHS Constitution which is due to be redrafted. It won’t always be possible, just as jury service isn’t always possible, but those who can would add to the existing volunteer hospital ‘friends’ who already see it as a good thing to support their local NHS. The Francis Report should be an opportunity for us all to reflect on how much we value caring. This is no bad thing, as Socrates said, ‘the unexamined life is not worth living’. It’s a chance we must not miss, and we mustn’t think simply applies to the nursing profession. It applies to us all. The founder of the Ritz Carlton hotel chain was once asked what was the secret of his success? He said that to everyone in the company, whether a receptionist, manager or cleaner, the maxim was “Ladies and gentlemen serving ladies and gentleman”. If we, or even the NHS as a whole, can regain this as our attitude towards each other, serving, caring and respecting each other no matter our role or age, then there is hope for nursing, and Francis could initiate a lasting legacy.