Posted by: ayrshirehealth | April 24, 2013

When Will the Lessons Stop? by @fionacmcqueen

Lessons from Stafford  

What do the CERN Hadron Collider, Charles Dickens and Robert Francis have in common?

On the face of it very little.  However look a little deeper.

Questions 4Question 3The quest for a Higgs boson is one that many thought would never be realised; but through years of dogged determination, the discovery was made.  The quest for harm free patient centred care at times may seem as complex as the quantum physicists’ challenges, however although time and time again, we provide outstanding care within the NHS, at other times patients and their families are left feeling hollow.  Questions 2In particular families of the 1200 patients who died in Mid Staffs I suspect feel no different from the families of those whose suffering Dickens highlighted over 150 years ago.  Come in Sir Robert Francis.

The Francis Inquiry

‘I mean in some ways I feel ashamed because I have worked there and I can tell you that I have done my best, and sometimes you go home and you are really upset because you can’t say that you have done anything to help.  Questions 5You feel that you have not – although you have answered buzzers, you have provided the medical care but it never seemed to be enough.  There was not enough staff to deal with the type of patient that you needed to deal with, to provide everything that a patient would need.  You were doing – you were just skimming the surface and that is not how I was trained.’

Questions 7

These I guess are words that many clinicians can relate to and indeed may feel at the end of a very busy shift.

Unfortunately they are the words of a nurse who gave evidence to the Francis inquiry.  Feeling like that on the very odd occasion when there have been exceptional pressures might be acceptable – but every day?

A doctor said;

‘If you are in that environment for long enough, what happens is you become immune to the sound of pain.  You either become immune to the sound of pain or you walk away.  You cannot feel people’s pain, you cannot continue to want to do the best you possibly can when the system says no to you, you can’t do the best you can.’

Putting Patients first

When health care practitioners are challenged about putting patients first, we can often be indignant.  Indignant at the very suggestion that any of us do anything other than putting our patients first.  What happens then when we cant’, or won’t, do that?

We probably accept that on a minute by minute basis each patient in our care gets our full attention – but what is full attention?   Professor Steven Wright talks about clear eyed and glassy eyed.  The clear eyed nurse being with their patient, and the patient knowing that for the time they have the attention of the nurse, they are the centre of everything the nurse is doing.  He goes on to describe the glassy eyed nurse who carries out the same physical tasks as her clear eyed colleague, but the patient knows the nurse’s attention is anywhere but with him.  Is this what the Mid Staff’s nurse meant when they said they were ‘doing’ – in essence doing rather than being?

Questions 6Over a century after her death, Nightingale continues to have relevance today – urging us to do the sick no harm, but interestingly also recognising ‘how very little can be done under the spirit of fear’.

Fear of what?

  • Fear that if you raised a concern about care, the nurses would be spiteful to your relative when you left?
  • Fear that if you rocked the boat the veiled threats of it not being good for your career would be enacted?

What if the horror of Mid staffs revealed a malaise  not only in the hospital and health service, but something altogether deeper?  What if it is not just NHS culture – important though that is –that has been exposed, but a larger, more enduring human weakness?  One of an inability to put others before our own needs; either our need to keep our head down and survive another shift; or our need to keep a façade of coping whether it’s organisational or personal.  A fear of doing the right thing?

In the 1860s Dickens and Gladstone were both appalled at the conditions in the workhouses – over 150 years later – society is again appalled – whether it’s Mid Staff of Winterbourne View.  Can restructuring or changes in systems really make things better?  Will enforced labour of prospective undergraduate nurses improve the profession?  Or will it drive our best recruits into another profession?

Or is it a time to hold our nerve?  I believe our Scottish NHS is in a unique position of taking an ambitious countrywide view on improving health and improving care until we have a truly world-class health service.

Questions 8NHS Scotland (and Ayrshire in particular) staff do an amazing job and are extraordinary every day.  Tribute after tribute is paid to our staff who go the extra mile and really make a difference to people’s lives.

However we can and must do more to move towards that world class health service we all deserve.  So like the scientists at CERN, let’s keep searching until we’ve found that elusive formula for  every patient every time.

@fionacmcqueen is Executive Nurse Director in NHS Ayrshire and Arran and Chair of the Scottish Executive Nurse Director’s group.

Next week our blog is by NHS Scotland General Manager trainee with NHS Ayrshire & Arran @cameronasharkey 

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Responses

  1. Patient centred care is so important as well as listening to patients. It was only through sheer strength that my mum eventually got to see another doctor for another opinion about her initially misdiagnosed cancer. Health providers need to listen to their patients, respect their opinions and not make them feel like a burden. Thanks for the post

  2. As a patient and carer the point about pain and being immune to the sound of it is well made. Also the clear-eyed nurse who is watching out for the patients under her/his care, along with compassion and a certain degree of empathy. For it could be any one of us having to receive inpatient treatment or visiting in hospitals and seeing what is or isn’t being done in the best interests of the patient.

    My most recent experiences have been as a mother and carer of sons in the psychiatric system, inpatients of psychiatric locked and open wards. It hasn’t been a positive experience, the negatives far outweigh the positives, and mostly to do with the point about being immune to a person’s pain. When people are in mental distress it isn’t easy entering their world and feeling their pain. Much easier to drug and subdue, silence their voices even if it takes some restraint and compulsion. Yet the reasons for the pain won’t go away just because the patient has been drug is in their system.

    In a general hospital pain relief would not be the only treatment. Obviously there would be an investigation into what caused the pain, where the injury was, how it could be fixed or treated, followed by therapy so that normal living was resumed as soon as possible. In a psychiatric hospital the shutting out of pain is paramount and therapy doesn’t always go hand in hand but can come later, sometimes delayed until a person is compliant and, according to the psychiatrist, has ‘insight’. Non-compliance is equated with lack of insight. Which just means that the patient doesn’t want the brain altering psychiatric ‘medication’. Especially if they’ve had it before and know what it feels like.

    I suppose what bothers me most about the issues in psychiatric hospitals is that society might not be so appalled at poor nursing practice or over-stretched staff. They may not even hear about any issues because they aren’t often front page news, the problems to do with treatment and care of the ‘mentally disordered’. Because the patients themselves might not have coherent and collective voices, and their carers and families are feeling too much pain themselves to be able to challenge the system deficiencies. Much easier to keep quiet and wait for pain relief, until the next time.

    I do want to see NHS in Scotland improving all their health services because it should have a positive impact on psychiatric care and treatment. Or that’s my hope and why I am involved in national mental health groups from the carer and survivor perspective. There has to be positive change for the sake of patients, carers and families, and so that the ‘first do no harm’ philosophy is maintained and sustained. Not an easy task in psychiatry where compulsory treatment is allowed and which can sometimes spill over into the use of restraint, seclusion and forced treatment. A no win situation for everyone involved and may result in a reinforcing of the trauma.

  3. […] When Will the Lessons Stop? by Fiona McQueen. […]

  4. […] McQueen was asking difficult questions in When Will the Lessons Stop? on the Ayrshire Health blog, following the publication of the Francis inquiry into […]

  5. Reblogged this on Fiona C McQueen and commented:
    This blog originally appeared on the Ayrshirehealth blog on 24th April 2013


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