During a debate in London this week with health colleagues we were updated on the initial responses to the report into Mid Staffordshire by Robert Francis Q.C. which was published in early February 2013. The long awaited report is hyper-critical and leaves no stone unturned in an attempt to uncover the reasons why over a thousand lives were lost in the Trust.
In the Government initial response “Patients First and Foremost” I learned that there are 5 key themes. They are preventing and detecting problems, prompt action, robust accountability and ensuring staff are trained and motivated. It was at this point I posed the question: can you teach care? Is caring a quality a person is born with or can it be taught?
There has been criticism of the care patients in Staffordshire received in Robert Francis’ report, and there are underlying concerns that there are “pockets of Francis” still remaining in other parts of the NHS and that this report marks a watershed in the 64 year life of the Institution so in the future care will be referred to as “pre Francis” or “post Francis”. What is welcome is that Skills for Health have produced a code of conduct and training standards for Health Care Assistants in the NHS which will cover the essential items needed for induction training, Wales and Scotland had already written a code of conduct and standards which has been in place a few years but HCA’s remain unregistered despite UNISON campaigning for their registration.
HCA’s are only part of the picture, Qualified Nurses and Doctors are registered as are Radiographers, Paramedics and other Health Care Workers who a patient encounters on their journey through the NHS system. In a day the patient can see and be seen by a number of unregistered people including Admin Staff, Porters, Domestics and Volunteers. Did these groups formally learn to care for patients, did they acquire care or are they caring by nature and apply the care to the role they undertake.
The initial response from the Government to Francis also suggests that student nurses will during their full nursing degree, have to spend up to a year helping patients to eat, wash, dress and go to the toilet to help break down the barriers and supervision issues between HCA’s and Qualified Nurses.
I have some insight into this issue as my own cousin is currently undertaking a nursing degree in a local university and is currently on placement in the local general hospital. She works hard on the ward as part of the team. She is in a good university with great dedicated tutors and values her placement time as key in gaining practical experience to support her acquired knowledge. She is learning the skills she will need to be a good nurse, she already cares, I know she does but how do you measure it, there is no care exam at the end of the course. That is because care permeates through everything that a nurse will do whether qualified or a HCA. It is not just kindness, it is consideration of all the patients needs, it is timely, it doesn’t switch on and off, it is practical, it is reassuring, it is thorough, inclusive, care is holistic and individual needs catered for, communication is crucial and the most apparent feeling the patient will have is that they feel safe. This can be defined in one word: professional.
A professional considers the patients needs, will wash their hands between treating patients, will talk and listen to patients to determine their welfare, effectiveness of treatment, reassure patients, ensure they are comfortable,maintain the patients dignity, keep them clean, warm, feed them, liaise between other health professionals, be the patients advocate, be inclusive, keep clear confidential records, handover all aspects of the patients health to the next shift, keep relatives informed, and answer all their questions …oh and call the patient by their first name and, on occasion …hold the patients hand.
I am a visiting lecturer at a University once a term on their Parmedic course. It’s a bit of a stretch calling myself this but they did keep me a car park space for when I arrived there. I had some insight into what makes students on a course tick. Nobody told me what to say on my subject but it does cover the issues about looking after and caring for each other as professionals and it has the strongest link to patient care.
I was told about the course that dealt with the whole body system. Previously the Ambulance Service would receive a 999 call for a lady with an arm injury, the crew would arrive at the workplace and ask who has hurt their arm, then they would be pointed in the direction of the lady whose arm was injured and proceed to speak to the lady about her arm, examine her arm, treat her arm and then proceed to take her arm to hospital and then handover to the triage nurse pointing at her arm which by the way was attached to the rest of her body throughout. On the course the Advanced Paramedic were taught that they would have to look and determine what impact the arm would have on the rest of her body and what illness or previous injury to her body would have on her arm. They had to look at the whole patient, the history was not just of the injury but the whole medical background, current previous injuries or illness, their treatment was based on the whole body, the pain relief was for the whole body …they took the lady to hospital not just the arm with a lady attached.
My belief is that recruitment is the key to success where care is concerned, it is measurable, it can be demonstrated even at interview. It is not good enough to say that you want to care for patients you should be asked how would you care for them. If the answer was I don’t really know but I could hold a patients hand for a few minutes …then that is a good start.
We all can learn to care.
Courtesy of Joseph Conaghan at Joe Blogs