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November 30, 2003
Fallen angels
Brilliant, devastating, heartbreaking and utterly, utterly true description by Harriet Sergeant in Saturday's Telegraph of the moral and professional implosion of nursing. She describes the effects of a catastrophic philosophy that has simply driven caring, kindness and common sense out of nurse training. Here's a sample passage that made me sick with recognition: '...a second-year nurse was taking care of six patients, unsupervised by a senior nurse. An old man wearing an oxygen mask was sitting in bed, staring disconsolately at a wash bowl. Next to the wash bowl lay his breakfast, uneaten, and beside that, an overflowing sputum pot. A full bottle of urine dangled beneath the bed. The nurse had left him with the wash bowl "to do what he could". No one had taught the nurse that she should clear everything away first, remove the urine bottle and then present the bowl of water. No one had taught her the purpose of nursing: to do for the sick what they cannot do for themselves'. As Sergeant relates, politically correct theory has driven out of nurse training the practicalities of nursing: 'At a London A&E department, a staff nurse who had recently qualified complained to me that her training had not prepared her at all. In 18 months of study, she had spent only one and a half hours learning how to take blood pressure and a patient's temperature. On the other hand, a whole afternoon had been devoted to poverty in Russia...The staff nurse had been astonished to discover how little anatomy or physiology her course contained. Anxious that her grasp of these essential subjects was "not as good as it could be", she approached her tutors. But they took a relaxed view. Soon, she discovered that her ignorance did not matter. Her first exam, tackled after 18 months, was multiple-choice; her final exam, at the end of two and a half years, allowed her to answer three out of six questions, and so avoid revealing her ignorance. For assignments, her tutors had set her work on social issues and ethics - including patient rights. That patients might have a right to a person qualified in how to look after them did not seem to have occurred to her teachers. She said: "Theoretically, you could go through the whole three years without anyone asking you about bed sores." ' The results are as predictable as they are distressing. 'A consultant anaesthetist at a London teaching hospital complained of patients arriving for operations with bed sores. On ward rounds, he frequently found himself helping patients to eat. "The catering staff slam the food down. No one bothers. Spooning food into a patient is just too demeaning for professional nurses, it seems. I always thought nurses were meant to care for patients. I might be wrong. I may have missed the plot somewhere.'' Another described the difficulty of trying to find a particular patient on a ward. Every patient is supposed to have his name above the bed. But, in some hospitals, they refuse to display the name "in case it infringes your autonomy". So the consultant found himself wandering around, trying to find his patient. "There never seems to be anyone in charge who knows anything," he said.He would try to find the patient's nurse. Then the patient's notes. "I don't often strike lucky with all three." Finally, he had to translate the nurses' diagnoses. "They refuse to use hierarchical, male-dominated medical terms, so they will not say the patient is unconscious. No, the patient has to have 'an altered state of awareness'.'' ' There are many other distressing examples in this piece, extracted from a pamphlet to be published next week by the Centre for Policy Studies. Of course, these experiences are not universal. If you are youngish and articulate, or if you are in an intensive care unit full of the highest-tech whizzbangerama, you may well have quite an agreeable nursing experience. But if you are old, inarticulate or worse, it's a different story. The source of the rot is a feminist orthodoxy which says nurses must no longer be the 'handmaidens' of male chauvinist doctors but instead must be their equals. 'Caring', therefore, can have no place any more in nursing since it demeans the nurse. Making sure the very old and incompetent actually eat, or making them comfortable in bed, or helping them wash or dress in a way that maintains their dignity, are all beneath too many modern nurses. Wicked stuff; and nothing short of a collapse in the moral heart of nursing itself. Posted by melanie at November 30, 2003
Comments
The pernicious canon of feminism has wrought destruction right across our society. It is not good enough to be a woman. The feminine gender has to be the same as (but better) than a man. And so we have masculinised women and feminised and cowed men, many of whom seem to be jumping their gender ship and opting for the third way of homosexuality. This short-sighted perversity is leading to the collapse of our christian civilisation and its likely supercession by a fundamentalist islamic creed that will roughly put women back, not where they were 50 years ago, but more like 1,000 years. That's real progress isn't it. Posted by: Cantfree at November 30, 2003 10:27 PMMy wife is currently taking a 'back to nursing' course in the UK after 8 years as a full time mother. She trained at Barts under the ancien regime and is puzzled by the 'coursework' she's being given now. She's currently looking at three set texts "Nursing Rituals" by Mike Walsh and Pauline Ford '... the unquestioning tradition of obedience ... Victorian legacy ... this involves obedience to hierarchy and also to men, who, according to Victorian values, are seen as inherently superior to women. It is no accident that most nurses are women and most doctors are men.' A later work by the same pair 'New Rituals for Old' 'being powerless is synonymous with being oppressed (tough being a baby then - LT) and one of the principal tenets of feminism is that women are an oppressed group. About 85% of nurses happen to be women. It is hard to ignore making a linkage (sic) betwen these two statements, and, in addressing the issues of empowerment, feminist perspectives therefore deserve our immediate attention.'. The theme of this book appears to be that 'we've thrown out all that stuffy old tradition and we're STILL oppressed'. And 'Nursing Models and Nursing Practice' by Peter Aggleton and Helen Chalmers. .. 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. It was not until 1967 that Yura and Walsh argued that nursing care ... should be likened to a problem-solving process in which nurse and patient Love that 'reflect on what has happened'. Presumably only if you're still alive. My mother was subjected to this last approach (known as "the nursing process") when she was dying of cancer a year ago - a charade of equality. It was a pity that during this dialogue her night nurses made plain to her their displeasure at having to take her to the toilet several times a night. When I was studying sociology and annoying my tutors, my wife was learning nursing at the sharp end in London casualty units. It looks as if the 'return to nursing' courses are not designed to update the returnees in clinical practice, new drugs or techniques, but to reprogram them into a new nursing ethos, one in which the nurse and her status are all-important. All for the patient's good, you understand. This is very frightening. Has anyone heard of this kind of thing in the U.S.?--usually we seem to have similar pathologies in Britain and in the U.S. I do think that there is far too wide a divide in salary and organizational power between doctors and nurses...I can't think of any other industry with such a sharp class distinction. This kind of thing isn't the way to fix it, though. Posted by: David Foster at December 1, 2003 12:25 AMIt's simple, like the police and armed services, nursing was seen as a vocation, now it is seen as a career. Posted by: gasky at December 1, 2003 12:35 AMgasky, I think teaching can be included in your list too...maybe if caring, both practical and psychological, had been valued in the first place, it would not have been posible to hijack nursing in this way? No wonder that they cannot find enough nurses and midwives, and so many of those who do qualify, leave. Posted by: mrs s at December 1, 2003 02:28 AM"Spooning food into a patient is just too demeaning for professional nurses" . . . But not for a Queen -- at least not when Elizabeth I sat beside Burghley's bed in his last illness and fed Melanie, One is all too used to encountering the excesses of multiculturalism and heartily sick of gay rights. But feminism is relatively mature in that core issues like equal pay for women and equal rights at work enjoy general support. Thus, its excesses have a tendency to fly under our radar somewhat. The reality of its marxist-cultural nature and purpose remains, however, and is no less disgusting than that of the other two aforementioned engines of change. Thanks for a sobering and moving post. Posted by: Guessedworker at December 1, 2003 10:40 AMI understand modern doctors are not too well-trained either; some cannot take blood, then again many nurses cannot. We live in an era of the theoretician and then denigration of the practical. Many years ago I recall a Stanford-trained 'engineer' without any practical engineering skills, he could not turn metal. We are evolving into Hermann Hesse's Glass Bead Game of ivory towers. We know THAT but do not know HOW......and it is becoming farcical that a country which always was too theoretical because it could not afford to do practical things now has become esoteric. Where is the world of Meccano and of building, replaced now by the audio-visual representation of a structure in place of building it. Knowing the theory of taking blood and examination is not the same as sticking the needle in the right vein and not botching it. How good it is to have an experienced nurse or doctor do it properly, rather than the embarrassing scene of a "trained" person seeking another vein for another attempt Posted by: John of Gaunt at December 1, 2003 03:05 PMI too read this article recently and was horrified...a very long way from the clean, efficient wards run by the formidable 'matrons' who ruled until the 1970s. My only trip to hospital (UK NHS) as a patient was in the 1960s when as a small child I had my tonsils removed. I can still clearly remember the incredible care I received in the children's ward from devoted nurses who had a wonderful, comforting bedside manner to a (sometimes confused and frightened) young child who was away from his parents from parents for the first time. I am sure there must still be such devoted people working in hospitals, but - as with state education - it is the 'theorists' and 'consultants' who now set the ethos and consequent rules, regulations and procedures that determine the quality of patient care. Posted by: David at December 1, 2003 05:04 PMTo David Foster (and anyone else interested in the American medical experience): Activism isn't (yet) the center of everyday life in the U.S., such as Melanie's "antinurse". However it has touched it in another way. Here, where job security is big in a realm where many minorities apply, the field bound to be infested with the socialist attitude, a natural consequence of their job security. Hence nurses know that their being in high demand ensures they keep their job, and don't work as hard. Apathy strikes harder the older you get. Why spend millions adding a year to an old life when those millions could somehow prevent the deaths of three people a fifth their age? Cold, but inevitable. The old are expected to sacrifice for the young. Apathy strikes harder the less important you are, and the medical realm is no exception. (Many American movies are based on this reality). As you get older, assuming you're not famous, you have less and less people to support you and to pull strings for you. Last, one of the biggest problems is the dearth of English speaking doctors. Immigrant from ALL OVER have filled this void. Imagine you can't communicate that you're sick. My word that's annoying (and possibly dangerous). Posted by: ditariel at December 1, 2003 11:05 PMThere is an article on exactly the same subject in the December issue of Prospect magazine. It's by Julia Magnet, an American living in London who spent two weeks in a "world-famous London hopital" where "true care was, for the most part, absent." As a sufferer of a complex autoimmune disease, Ms. Magnet says she is something of an expert on hospitals. It's a hefty article, so I'll only give you a flavoring here of what she said. Anyway, she writes that she couldn't figure out which nurse was responsible for her, who was in charge of the other nurses, who could give intravenous (IV) medication, and who could only take blood pressure. Of the squadron of nurses hovering around her neurological ward, there weren't any she could rely on to know her diagnosis; and some nurses kept offering her inappropriate drugs. "People would come in without knocking to dump pills on my table," Magnet writes, "yet no one bothered to ask me if I was vomiting up those pills—as I was. Instead, I was repeatedly asked the same inane question, 'how bad is the pain, from one to ten?'" Ms. Magnet says that what was profoundly wrong at that hospital was that "nursing—in its most basic sense, care—was almost entirely absent." "There is something in nusrsing that runs absolutely counter to the instincts of the modern world. Our age concerns itself with empowerment, personal rights. Nursing, when it is done properly, is about self-abnegation. The profession requires the nurse to put him or herself second, and the patient first. A doctor friend told me of a young nurse on his ward, a nice chap, whose face was filled with ironmongery—nose, lip, tongue and eyebrow pierced. This frightened elderly patients. My friend mentioned the fact to him; perhaps he might consider a change of attire? 'Piss off, man; this is my human right to self-expression,' he replied. But nursing shouldn't be self-expressive. In nursing, ideally, you realise yourself through service to others." "Modern nursing," Magnet adds, "has tried to stamp out the idea of a 'calling.' Theory, bureaucracy, and an obsession with status have replaced the old duties of corporal charity—works of bodily mercy—that bound a nurse. Magnet says that nursing courses are "50 per cent theory and 50 per cent practice—and 100 per cent indoctrination in bureaucratic circumlocution." The idea is to make nurses autonomous practitioners, the equals of doctors. The result is a nursing profession embedded in a power struggle, against doctors, the NHS, even patients—should patients ask nurses to do anything that undermines their status. The courses are a "pure distillate of PC humbug, the usual mix of victimology, identity politics, and class struggle." At one nursing school a required course looks at, in the school's words: "the social context of health and healthcare, which considers the relevance of sociology and health policy to heathcare. Integral to the course is exploration of key sociological issues, which influence healthcare such as poverty, gender, social class, ethnicity, and race...At the end of this course you will be able to begin to recognise the improtance of practising in an anti-discriminatory way." Magnet tells of a friend's mother who returned to nursing after 23 years of raising a family. When she retrained under the new system, she found it frightening: "They spent all our time on the structure of the NHS and responsibility for your actions with the NHS. You're responsible for your actions in life; why is it different in the NHS? And teaching about understanding that the patient is in pain! If you're a nurse you should bloody well be caring about that anyway! But they only spent an hour on drugs, which was what I needed to learn. At the end of it I was offered a job in the NHS and I thought no way, I'd be a danger to the patients, I hadn't been taught enough about the new drugs." And so on. You get the picture. Posted by: Joanne at December 2, 2003 11:38 PMIf that experience was in London, it was probably agency nurses.....London spends over 50% natiobal budget on agency nurses because noone wants to work in the place. I still believe London hospitals should be moved out of the city altogether and turned into luxury flats.....it is ludicrous to try to employ low-paid medical staff like doctors and nurses alongside merchant bankers in an overheated housing market Posted by: Romulus at December 3, 2003 06:59 AMJohn of Gaunt, I so agree with you regarding the Ivory Tower thing. I don't know much about the US hospital system, having been blessed with excellent health, but as a mother of two I've had the "pleasure" of dealing with the US public (state-funded) school system for two decades. What the theoreticians have done to our school system is tragic, and those who suffer the most are the poorest and most disadvantaged, in whose name all the lunacy is so often being perpetrated. The theoreticians escape to the affluent suburbs and send their kids to decent state-supported schools while leaving the inner-city, poor and minority children, to the tender mercies of their own looney educational fads-du-jour. Posted by: Susan at December 3, 2003 10:28 PMRomulus, "I still believe London hospitals should be moved out of the city altogether and turned into luxury flats.....it is ludicrous to try to employ low-paid medical staff like doctors and nurses alongside merchant bankers in an overheated housing market"... Difficult to know whether you are being satirical or serious...or just indulging in black humour. What is needed in London is affordable housing...! London is alone in Europe in having such huge differentials in property prices that it is virtually impossible for essential workers such as nurses and firemen to live there. Hopefully, the market will adjust itself with a much-needed downward shift so that housing becomes more affordable for essential workers. Posted by: David at December 5, 2003 04:08 PMGratitude is not only the greatest of virtues, but the parent of all others. Posted by: Lashutka Michael at December 11, 2003 08:30 AMIt's a sign of mediocrity when you demonstrate gratitude with moderation. Posted by: Arle Genevieve at December 21, 2003 09:23 AMPeople who do not think far enough ahead inevitably have worries near at hand. Posted by: Huang Kenneth at January 19, 2004 06:35 PM |
