Monday, February 11, 2013

Some Start To Get It ...

Well, it only took between 400 and 1,200 deaths at a single hospital, but it's starting to get through :

"When I asked people who worked, or had worked, in the NHS what they thought had caused the biggest changes in nursing care, nearly all of them mentioned something called Project 2000. This was a new system introduced in the early 1990s, which moved the training of nurses out of hospitals and into universities."

I blogged the remarkable change to nursing training in 2003, having seen the results first-hand when the caring nurses on my dying mother's ward made it plain that they didn't want to have to take her to the toilet, and having seen the set texts when my wife took a 'back to nursing' university course after a career break.

"... until relatively recently many nurses believed that nursing is best carried out when based on instinct, intuition and empathy, elements that make up 'the calling' ... such an approach ...has since come in for considerable criticism."

Thus 'Nursing Models and Nursing Practice' by Peter Aggleton and Helen Chalmers, recommended by university lecturers throughout the land . You can't say that criticism's not been taken to heart.


Ryan said...

Hmmm. I can certainly understand that moving the teaching of nurses into university hasn't helped, but I'm not sure it is all of the problem.

My young wife couldn't get a single nurse to administer a simply suppository after a C-section, regardless of the nurses age, training or level of seniority. They would postpone each request until the end of their shift and hope the next nurse would deal with it. I actually got so angry about it I demanded to administer the suppository myself. At this point a senior nurse did step in, looking rather shame-faced. Really, is it that difficult or unpleasant? Makes you wonder if squeamish nurses are cut out for the job and maybe that's where the real problem lies - maybe university training was used to sucker women not really cut out to be nurses into believing they could hack it when later it turns out they can't (I had a friend that told me about cleaning out the sluices in the operating theater and finding aborted feotuses in there - so I guess it's not a job for the faint-hearted and maybe being "caring" is actually attracting too many "hand-wringer" types and not enough tough-nuts that get the job done).

I don't know that healthcare is about caring. We have several doctors in our family and it really isn't about caring. Care too much and you average health professional would go nuts - too much pain, suffering and death to cope with. Unfortunately this mean patients are simply "problems" and the NHS would work much more smoothly without them. Health care systems which are free at the point of use but where the patient retains buying power work much better than the NHS as far as the patient is concerned.

I also notice a growing willingness for drug companies to develop expensive "therapies" rather than cures. Is pumping the human body full to the brim with expensive drugs the best way to deal with a tumour? It wasn't for Lance Armstrong - he had his 5 tumours cut out with surgery, never had chemo and was racing again in 6months (some fight against cancer that was....)

Anonymous said...

Caring doesn't mean emoting all over the place, or as you say no one could do the job. But it does mean obeying the Golden Rule - treating others as you'd want them to treat you.

"maybe university training was used to sucker women not really cut out to be nurses into believing they could hack it when later it turns out they can't"

Something in that. When you started on the ward back in the day after six weeks in class, you were straight into washing, feeding and bottom wiping. The cultures changed as well I think - not much entitlement and self-esteem in those days. Now they're taught that they're mini-doctors - and that they're oppressed!


Ryan said...

I notice a growing trend for doctors to only work 2 days a week. I'm guessing this is because doctors get paid only for having patients on their books, not because they have provided treatments. It seems the growing number of super-surgeries are the root of the problem because the patients have nowhere else to go and the doctors can do as they please.

It seems your average Joe is unwilling to complain about a 1 week wait for the GP - with no real means of getting around the GP service (even privately) the patients are probably too scared of what the GPs might do to them if they stand up for themselves.

Fahrenheit211 said...

Ryan, I also know people with responsible jobs who refuse to bring their stress related problems to the NHS GP for fear that this problem will end up on some sort of government 'list' which will have a later negative career impact.

I have a relative in one of the more 'islamified' London Boroughs who was told that if he complained about his GP, then a false racism and prejudice counter claim would be put in against the complainer.

Sod the NHS it has completly failed to serve its primary customers, the patients, correctly.

Anonymous said...

I am a police officer. My mother was a nurse. She trained in the 1960s. I trained in the ‘90s. I see parallels in both professions in their recent development and resultant public dissatisfaction.

Towards the end of her service, my mother used to comment frequently that many younger nurses placed a greater priority on record-keeping than dealing with patients. An example was a nurse who wrote “Patient verbalising pain” on a terminally ill patient’s notes rather than getting the patient medicated and holding their hand as they passed on. Many thought that wiping bums and showering people was beneath them.....”obviously, it’s something you have to do in training, but now I am a professional” my mother quoted to me in disgust. It further infuriated my mother that these people viewed wiping bums and feeding people as distractions from working on their promotions away from such menial tasks. “She can’t even make a bed” as my mother used to say.

In my own “profession” I have experienced similar issues. I was first on scene at a fatal collision (a horribly common occurrence. When the (new) sergeant arrived to “supervise” the incident he pulled me to one side and said “Mate, I’ve never been to anything like this before. I don’t know what to do”. It transpired that after being “tutored” or “puppy-walked”, my new sergeant, who was a “bright young thing” and had gone straight into an office role, supervising paperclips or something, was unable to deal with a basic policing issue, let alone supervise me and my colleagues. I know he can talk about “diversity” “communities” and use the latest buzz words (or he would never have been promoted with two and a half years service, but he couldn’t do the basics. I don’t blame him for that. There is something inherently wrong with a system which promotes people in a “vocational” role who have never performed or experienced that role. Every operational police officer will have numerous similar examples. I have met Chief Inspectors who my force computer system shows have made less than ten arrests in their careers! I can do ten in a week!

My point is, that in occupations such as nursing and policing, fire fighting, ambulance service and numerous other “vocational callings” there has to be a decent grounding in and respect of the basics. A minimum term of five to seven years should be spent as a ward nurse, operational constable etc before the individual can even be considered for ANY other role. Some say that this would deter “high calibre” or “high potential” individuals from applying to join these organisations. I would say “if they won’t do this, why do we want them to?”

Ryan said...

"My point is, that in occupations such as nursing and policing, fire fighting, ambulance service and numerous other “vocational callings” there has to be a decent grounding in and respect of the basics"

I can certainly see that. In fact it applies to every profession. I'm an electronics engineer and we still see graduates leaving university that don't know what a real resistor looks like. University teaches - but it doesn't train.

I was struck by the comment in the Independent report that Laban linked to - which mentions that nursing has become very technical since the 80s. Eh? Why is it more technical now than in the 80s? What new treatment has come along that requires highly trained nurses that was not around in the 80s? Even if this WERE the case, does it apply to the majority of nursing jobs? Is maternity care very technical now compared to the 80s? Seems unlikely to me. Sounds like self-justification for making nursing technical rather than the other way around. One of the doctors in my family told me that being a doctor is actually not particularly technical. GPs knowledge is very superficial and the treatment options are so limited at a GP surgery it is a matter of picking from one of 5 options or making a referral. In a hospital there is so much specialisation that the options for treatment are even more limited for a given consultant - typically cut the problem out or treat it with one of 4 drugs! All the real technical stuff is done by top consultants in league with drug companies and scientists, not by the consultant in your local hospital. The BBC in particular likes to peddle the myth that the average consultant is some sort of guru - this is not the case. Operations and therapies are made as routine as possible. Somehow they still get them wrong and nobody looks into why.

JuliaM said...

"Eh? Why is it more technical now than in the 80s?"

More equipment to supervise and monitor?

Ryan said...

""Eh? Why is it more technical now than in the 80s?"

More equipment to supervise and monitor?"

Yes, granted, but from what I have seen most of that equipment is so easy to use a child could monitor it. After all, a lot of those devices are electronic gadgets that are used to control drips and heart rate monitors that would previously have been a manual exercise.

Look, I've been in and out of hospitals for years for one reason or another. Most of that high-tech equipment has been developed with the sole purpose of giving the health-care professional the possibility of setting a patient up in the morning with all necessary drips and heart monitors etc and then leave the patient there unattended all day knowing that if anything is medically wrong the electronics will set off an alarm. Setting up this equipment is no more difficult then doing things "the old way" from what I can see - the equipment has been designed to make it easy (certainly easier than operating a smartphone).

I'm guessing that the powers that be have just ASSUMED that it is all a lot more technical without realising that the hardest bit is still the visceral part of putting in needles and catheters, just as it always has been.

What I would say is this:

When a patient needs morphine for pain she needs it NOW - not when the government target of treating all the children in A&E first has been met. It really isn't good for children to listen to a grown adult woman screaming in pain at the top of her lungs anyway.

Just because the electronic equipment means you can leave a patient on their own all day does not mean that it is reasonable to leave the patient on their own all day.

A "nurse" that is squeamish about administering a suppository is not a nurse at all.

A nurse that completely fails to find a vein for taking a blood sample is not really a nurse at all.

It is the responsibility of nursing to ensure that the ward and operating theaters are hygenically clean - the cleaners are only there to work under the nurse's direction.

It is not acceptable for a nurse to prioritise chatting to her mates over the care of a patient, no matter how annoying the patient might appear to be.

Admit there is no such thing as "accident and emergency" - if the paramedic managed to get you to the hospital alive you are no longer an emergency. If you walked there yourself you are not an emergency. Consequently you aren't going to get emegency treatment in A&E because the "E" doesn't belong there in the first place. Yes I can see there is a desire in the NHS to try and claim that they can do the "E" when private hospitals don't - but actually it isn't true. It's just that private hospitals might struggle to reclaim the costs if you haven't been referred by a GP - the emergency treatment will actually be better at a private hospital because they insist on having a 24hr consultant cover for new admissions.

A nurse cannot safely be expected to do triage.

A nurse in maternity really shouldn't roll her eyes and complain about the fuss and noise being made when a woman staggers into the ward having just had a late miscarriage. Yes, we know nurses have "seen it all before" but really a nurse should at least try and give the impression of being more empathetic.

This is just some of the crap I have had to deal with thanks to NHS nursing over the years. Probably I would think of more given time - and this doesn't cover the consultants or general management of the NHS for which I have an even longer list of complaints. I'm just one person - put the list together of everyone's bad experiences and you'd have a list as long as an encyclopedia. I pay direct for private health cover because I simply won't inflict the NHS on my family anymore. I have often paid direct to circumvent the entire system including the GP when its been needed.

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