I’ve been working on a real ward with patients for a few months now. I don’t go often but I do it to try to make sure I still understand the experience of nursing. So far, my experiences say I do, as when I’m there with the patients it feels like I’m 25 again, it feels real and true.
Unfortunately I’m not so sure I look 25! When I go to the ward I put on my blue dress and sensible shoes; the dress is no longer a size 12. Ironically I wear a staff nurses dress which is the same colour as my old sister’s dress but no hat and no lovely silver buckle. I am wider and greyer – I don’t quite look the same as I did 25 years ago! You will understand the relevance of the way I look now later on in this blog!
Anne as ward sister 1989
Last week Jane Cummings CNO and Viv Bennett Director of Nursing at the DH started a consultation of a vision for nurses, midwives and care-givers; the vision includes dimensions of nursing characterised by the 6Cs, one of which is compassion. I would encourage you to read it and respond. You can do that here:
http://www.commissioningboard.nhs.uk/files/2012/09/nursing-vision.pdf
But it got me thinking – ‘Do I give compassionate care?’
Last time I was on the ward I was caring for a bay of 4 patients; its an elderly care ward but focussed on rehabilition. I love it. On my last shift there was one man in particular who, towards the end of my late shift as I was helping him to have a drink, said to me ‘I wish when I wake up in the night I would see your face. Its lonely here and so dark.’
What he said made me feel sad but also made me reflect. What did he mean?
Now, I’m pretty certain its not because I look like a vision of beauty in my dress. I never wear makeup on the ward and as I decribed earlier I’m not sure I look as I did 20 years ago. So why did he say it?
I reflected on the shift. This particular gentleman looks reasonably well but in fact has real problems with his mobility. I also noticed that he struggled to hold his glass to have a drink. Once I realised that he just needed a small amount of help I tried to go to him often to help him to drink his juice. When meal time came I sat quietly down with him and offered my help. He was grateful, I think, as all he needed was help to put the food on the fork, he was quite shaky, but once it was on he could manage. We chatted a little bit but I am sure he was just happy that I was sat next to him. He ate all his dinner.
At the end of that shift I felt that I had made a difference to that man. I don’t want him to feel sad in the night but his feedback to me was that he felt better when I was there. Perhaps I was being compassionate?
So how do we know? We do know that kindness is part of compassion and that kindness needs to be attentive. Ballatt and Campling (2011) say that attentiveness is key to compassionate care, and cite examples such as noticing, thinking, feeling, learning and understanding as important. That these actions then lead to attunement characterised by empathetic warm engagement, responsiveness and sensitive caring (p. 44).
I think I was compassionate that day leading to a sense of trust, but critically I only knew I was through feedback from my patient. We need to listen to what they have to say be attentive and give them more opportunities for feedback that goes beyond ticking boxes of satisfaction. Story telling is powerful, allowing them to tell the story of their experience would help.
So I am resolved; be attentive, notice and give sensitive caring. At the end of the day I don’t look 25 any more but I hope I still have the skills I need to be a great nurse and to make sure I’m using them through listening carefully to what my patients have to say.
The references to ‘kindness’ and ‘attentiveness’ are from the book ‘Intelligent Kindness’ by John Ballatt and Penelope Campling which I would commend to you.
anniecoops 
Another great blog Anne. I love spending time on the wards when I can. I wonder if not being a regular part of the team & therefore not being so wrapped up in the daily pressures liberates you to take time with people and be in touch with your compassion?
Hi Mandy thank you for your comment. I’m not honestly sure that that makes any difference. I’m pretty anxious when I’m there as I don’t know the routine etc so there is a lot going on in my head. But I feel sure that I need to stay ‘attentive’ no matter how busy or distracted I am.
I found this to be very thought provoking, Anne. I think that due to the busy pressures on the wards (in my case this is a labour ward), we often don’t engage in conversation with people because we always have something else to do. But I think that this is so important to build caring and compassionate relationships with people. How else can we assess their needs and give them the care that they want? I believe that there has been an increase in complaints in relationship to this. I always try to maintain my philosophy of caring for women in a way that i would want to be cared for. And actually, it doesn’t take up much time and can make all the difference.
Great blog – do you know the work of Robin Youngson – bringing self-compassion and positive psychology into the hectic world of health care delivery. Recommend his book and the work he is doing in bringing people together to share what you are talking about here.
fabulous stuff – well done http://www.heartsinhealthcare.com/
Hi Anne, thanks for this reminder about attentiveness and compassion; crucial elements for nursing. They are applicable too to so many (if not all?) interactions we have as healthcare professionals. Thanks too for the signpost to the 6Cs; away just a week and I missed the launch.
Your blogs continue to serve as a reminder of the value of sharing such interpersonal stories; we can learn so much this way.
Anne – reading your blog reminds me why I seemed to gravitate towards care of older persons through my career. If you are not compassionate in your communication with older persons, especially those with memory issues, you get nowhere as a nurse and your job becomes twice as hard. How do we get that understanding into nurse training?
Hi Anne, so wonderful to read your reflection. I agree with you that you’ve made a critical difference to the gentleman, ensuring he was properly nourished and hydrated. Basis hydration and nutrition is so important and sadly often missed when we are so busy, particularly when someone needs assistance to cut food or to sip from a cup.
Some of this is to do with values- and I do think that recruitment is so much more effective when based not just on qualifications bu also on values. Qualities that made you a great nurse 25 years ago, and still today, of compassion, of kindness, and by paying attention not just to physical needs but also to emotional needs of your patients; these are qualities that all nursing staff should possess. So, my challenge is- how do we ensure values-based recruitment and appraisal, when we have (rightly) also got to consider clinical skill and knowledge?
What I love and what I missed Anne 🙂
Compassion is vital; we’re emotionally involved in the darkest times in pts lives which takes a toll we must acknowledge. I’m not surprised some staff chose to keep themselves ’emotionally safe’ and avoid caring too much. We could support compassionate care more if we acknowledge and support staff who can feel quite strong emotions after difficult times.
A lovely blog again Annie. Can’t really add to what everyone else has said but thank you for sharing your experience. and for tugging at the heartstrings of my innner nurse.
Dear Anne,
I was just about to go to sleep and noticed your blog on twitter.
I just wanted to say how much it means to not only the patient but also the relatives to know they are being seen, heard and understood.
I was a nurse and midwife for 20years in the NHS and my husband is currently very poorly in our local hospital.
When I go in I know who has been caring for him and ensuring he is comfortable and has a drink. Being paralysed this is more important than anything. If you can’t reach the called bell or your drink how vulnerable does that make you feel?
As the poem called ‘Kate’ or the ‘crabbid old woman’ says ‘What do you see nurses what do you see? Are you thinking when your looking at me?’.
Anyone reading this. Keeping looking…
Warm wishes
Julie New
@sunflowerjulie
Lovely post. I really miss working on the wards being able to spend that time with patients and being able to make a difference. I am a practice nurse now and have 15 min appt to see some patients, and sometimes patients have their own agenda which is often different to what we have and they just want someone to talk too .
Thank you so much to everyone who commented on my blog this week plus the tweets that also commented on what I was saying.
The comments helped me to reflect on a few new things that I wanted to share – after all, for me this blog is supposed to be about learning!
First of all compassion also needs to be applied to each other. Thank you Carolyn for reminding me how hard it can be to be compassionate if we don’t respect each other. This thought led me to more reading about ‘compassion fatigue’, worth looking up if you are interested. I found new reading materials that I might explore. Compassion fatigue, just in case you are not sure, is defined as ‘a disengagement or lack of empathy on the part of care-giving professionals’. We need to make sure we look after each other and watch out for when ‘Nurses, self-identified as having compassion fatigue, described a change in their practice by which they began to shield and distance themselves from the suffering of patients and families’. (Austin et al 2009). Supportive environments are vital for us to all remain safe. well and offer the best care possible.
Claire asked how we recruit for compassionate care giving and I admit I’m not sure about this one. I honestly don’t think I have ever met anyone that I don’t believe is capable of compassion. So is it that we don’t provide the environment for this to happen? Or maybe I’ve just been lucky? I did find this about compassion training:
http://www.bbc.co.uk/news/health-17104955
Do we all need reminding from time to time about attentiveness and listening?
Clair’s comment provoked me to think about compassion in different care-giving contexts. Is it easier in some types of care than others and is it affected by the patients expectations? I’m not so sure that it is. Having worked at NHS Direct, which I loved I learnt that it is possible to be compassionate even when following a strict protocol and you are working over the phone. You just need to be attuned and attentive to what callers are saying. But I could well be wrong, of course. Mandy’s comment was simialr to this but Sue’s somment about maternity gave me hope that I was right. But this is hard I think and it may be that behaving in compassionate ways IS more demanding depending on the context.
Finally- thank you Julie, for reminding me how much carers trust us to look after their loved ones. As I said in my blog, stories are so important for us to understand how it feels to be a patient or their carer. I aim to listen as hard as I can.
Thank you everyone.