NursingPracticeCOMMENT

“Practical skills must be taught to ensure compassionate care”

Recent reports into poor care have led to a heated debate about compassion in nursing. Many have charac-terised compassion as a per-

sonal characteristic or value that has been lost as nursing has moved away from voca-tion and towards a knowledge-based (and therefore university-based) profession. As a nurse with a doctorate, I can’t accept this argument.

It cannot be denied that there have been appalling failures in which personal care has been poor or absent; however, there is no evidence that nurses are less caring than in the past and certainly no evidence that student nurses have the wrong values. So why does poor care sometimes happen?

Compassionate care requires the right values and motivation but it also needs the knowledge and skill to deliver dignifi ed care. For the last 10 years, the NHS has been driven by a desire for productivity and effi ciency with a focus on completing tangible (and measurable) technical tasks. The number of nurses needed has been cal-culated on the number of tasks to be com-pleted, with personal care seen as unskilled and undervalued. It is therefore not sur-prising that some patients feel distressed when intimate care, such as washing, help to use the toilet and help with eating and drinking is undertaken in a manner that compromises dignity.

The government’s response has been to lay the blame on nurses and to recruit for specifi c values and make potential student nurses work as healthcare assistants for a year. This neglects the importance of com-passion as a skill that can and should be

SPOTLIGHT

Ending nausea allows dignity at the end of life Nausea and vomiting are usually acute problems that resolve in a short time. While they are distressing for most people, for those nearing the end of life they can make their fi nal days unpleasant and rob them of peace and dignity.

These unpleasant symptoms can often be eradicated or at least reduced by palliative care interventions. Our review on page 16 looks in detail at how nurses can tackle nausea and vomiting in patients with malignant or non-malignant disease, looking at pathophysiology, assessment and management.

As with so much nursing care, its success relies on

tailoring it to individual patients’ needs.

Enabling people to have a peaceful death is invaluable; it not only

improves their fi nal days but also reduces distress in families and other loved ones. What could be

more important than that?

taught. Providing intimate care for someone with whom you don’t have a rela-tionship, and who is sick, vulnerable and maybe distressed, is a highly skilled role. As with all complex skills, becoming an expert requires a thorough understanding of the theory and extensive practice.

We recruit wonderful student nurses, but I’m not sure if we always equip them with the skills to provide compassionate and dignifi ed care. When I started training, all nurses followed a standard pattern set out by the General Nursing Council, with three months spent in pre-liminary training school. As well as learning anatomy and physiology, we were taught the skills of personal care, spending hours learning how to give a bed bath and turn people with dignity. We continued to receive supervision in the delivery of per-sonal care during ward placements. Total patient care was the fi rst of the four formal assessments required to sit the fi nal exam-ination to become a state registered nurse.

Universities provide excellent simula-tion experiences, but I don’t know how the Nursing and Midwifery Council checks that students or overseas registrants have these practical skills to a common standard. Thousands of excellent students become nurses, but NHS complaints suggest others are falling through the net.

If nurses are not given the opportuni-ties to develop their practical expertise to match their values and motivation, we cannot criticise them if patients and fami-lies complain of a lack of compassion. NT

Elaine Maxwell is trustee at the Florence Nightingale Foundation

Ann Shuttleworth is practice and learning editor of Nursing Times. ann.shuttleworth@emap.comTwitter @AnnNursingTimes. Don’t miss the practice blog, go to nursingtimes.net/practiceblog

HIGHLIGHTS

Choosing venous access devices p12

Nutrition needs between hospitals and care homes p20

A programme to improve nutritional care p22

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