Time to care? Responding to concerns about poor nursing care

1. Time to care? Responding to concerns about poor nursing care Yvonne Sawbridge & Alistair Hewinson. University of Birmingham

2. (Available at: http://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/policy-paper-twelve-time-to-care.pdf • Key stakeholders • Literature search • Nursing think tank • 3 main themes: • -Environment of care • -Education & Development (“too posh to wash?”) • -Emotional Labour of Nursing

3. Lessons from history... • Previous scandals-Ely Hospital 1960’s, Normansfield Hospital 1970’s. • Walshe & Higgins (2002) found common themes 1969-2001 • Recommendations and action plans • ---issues recur

4. Walshe & Higgins 2002 • “Failures are organisational and cultural and necessary changes are unlikely to happen because they are prescribed in a report” • Key themes-Organisational & geographical isolation; inadequate leadership; system & process failure; poor communication; disempowerment of staff and patients

5. Key Findings: • Environment • Ward layouts-intentional rounding. • Ward sister/charge nurse role – 3 dimensions • Role overload • What matters is what’s measured

6. Key Findings:-Education and development • Apprenticeship and project 2000 both had problems • Attrition rates remain high • “.....nurses must be analytical, assertive, creative, competent, confident, computer literate, decisive, reflective, embracers of change and the critical doers and consumers of reserach. Most of these qualities were not inculcated in the old apprenticeship style..” (McKenna 2006)

7. Key Findings:Education & Development.. • Student nurses need to belong and enjoy good role models • Healthcare support workers • Mandatory training increased- funded establishment pressures.

8. Key Findings:Emotional labour of nursing • Hochshild work on flight attendants • “Induction or suppression of feeling in order to sustain an outward appearance that produces in others a sense of being cared for.” • Board recognition of this term? • Boorman report, Dawson & West • Systematic- not ad hoc - support

9. Coping with Caregiving... • I am in charge tonight with five nurses and 30 patients. Two of my nurses are floats who have never been on the floor; one will be an hour late, so I will have to cover her patients. Our ..patients have diagnoses..failure of the kidney, stroke, diabetes, cancer, sickle-cell disease, hepatitis, AIDs, pneumonia and Alzheimer’s disease. • The average age of our patients is 79. We have five ..post-operative patients and one going to surgery in two hours. As I come out of report one of our stable patients who transferred from Coronary Care Unit yesterday, is having chest pain.There is a Dr on the phone waiting to give admission orders and the anesthetist for our pre-operative patient wants the old chart, now. Down the hall an elderly confused patient has just crawled over the side rails and fallen. Two ..post-op patients,are vomiting as a side effect of the anesthesia,..their families are very tense and need reassuring. One of the patients I am covering for has just pulled out his IV; another wants something for pain; another needed the bed pan and I got there too late. The lab has called with a critical low haemoglobin level on the patient who pulled out his IV; he’ll be getting a few units of blood .. • Benner & Wrubel 1989 p365

10. Different perspective.. • “Staff don’t need more blame and condemnation; they need active, sustained supervision and support. In the high-volume, high-pressure, complex environment of modern health care it is very difficult to remain sensitive and caring towards every single patient all of the time. We ask ourselves how it is possible that anyone, let alone a nurse, could ignore a dying man’s request for water? What we should also ask is whether it is humanly possible for anyone to look after very sick, very frail, possibly incontinent, possibly confused patients without excellent induction, training, supervision and support.” • Jocelyn Cornwell, Kings Fund 17th Feb 2011.

11. The concept of caring..

12. “Kindness and compassion cost nothing” CQC Chair- Dignity & Nutrition Inspection report (2011)

13. Emotional labour of Nursing • 1950’s-Menzies work & 1990’s Pam Smith • Nursing as a series of “....disgusting, distasteful and frightening tasks....”Menzies IEP. (1960) A Case-Study in the Functioning of Social Systems as a Defence against Anxiety: a Report on a Study of the Nursing Service of a General Hospital. Human Relations 13(2): 95-121. • If anxiety not managed then burn-out can result and unhealthy detachment. • Rituals of nursing eroded- their role may not have been understood?

14. Group discussion • What do you think about the findings in the paper? • Are there any areas you disagree with? • Think about your role as a Governor in supporting nurses to deliver compassionate care-how do you do this? What helps/hinders?

15. Potential solutions • Samaritans • “buddy up” • Debrief post shift • Follow up if thought necessary • Turn off ‘phones-volunteers needs are priority.

16. Potential Solutions • Restorative supervision (Wallbank 2010) • High stress levels of HVs • Reduced effectively • AND means clearer thinking and ability to function/make difficult decisions

17. Potential Solutions • Schwartz Center Rounds (Goodrich 2011) • “supporting staff to improve care • Improving organisational culture • Reducing isolation • The value of a multi-disciplinary approach to problem solving, especially one involving senior staff”

18. Role of Governors-suggestions. • Actively consider links between support for workforce and patient care. • How often do you talk about complexities and challenges of providing care at the Council of Governor’s meetings? • What information do you have at the Board that tells you about the emotional well being of nurses (and others) • What would help/hinder your organisation in developing proposals for greater emotional support for staff? ?