All our yesterdays... or are they?

Comment & Opinion
Sue Smith, RGN, RHV, MSc

Sue Smith trained as a State Registered Nurse in the days of re-sterilising bandages and equipment, bottle/bedpan rounds and cooking milk puddings for ‘the gastric patients...’ However, a life-time both in both community nursing and nursing journalism, has given her great insight into the needs of patients.

Coffee time.... do you remember.....? No, of course I don't expect you to remember. You are young(ish) and bright, going about your daily grind of visits, clinics, meetings and--oh yes--recording everything on your iPads or tablets (non-swallowable), ensuring visits are planned, targets met, goals achieved, standards set, impossible objects moved. And so on.

Hang on a minute, there seems to be one crucial item missing from that list--oh yes, the patient or client. Or 'service user'? This is a bit like 'user-friendly'. Do terms like these make us more approachable to the 'user'? I fear these terms actually have a 'distancing' quality. Maybe that is the only way to do our pressured jobs now, to distance ourselves and practise like automatons--programmed to work by algorithm?


Do terms like these make us more approachable to the 'user'? I fear these terms actually have a 'distancing' quality. 

Uniforms, it was said, created a barrier so they were abandoned. But that barrier still exists. Have you ever been the patient in a GP surgery? As you're telling your problem to the doctor, you're lucky to get eye contact. They only have eyes for the screen or their fingers. We nurses are in danger of going the same way.

Back in the dark ages when hospitals and community nurses had patients, and health visitors had clients I seem to remember that observing and listening was vital. In the community, establishing a professional rapport with your client was crucial. It was only when the relationship had been built, could you hope that they would see you as the turn-to person if they felt a problem arising. In this way you could begin support and preventive action to avert a crisis, even when they weren't 'due for a visit'.

'Knowing your patient' was also the key to hospital nursing. I'm not suggesting a return to the 'non-nursing' duties I did every day as a student nurse in mid-20th century London, but I do recognise their value!

When damp dusting the ward at 7.30am it was during the few minutes around every patient's bed that gave us clues about their personal circumstances. Were there family photographs--or none? Was there evidence of regular visitors? This is what led to a few words with the patient as you wiped their locker. Rare one-to-one time when the patient was a Person, not a case-to-be-cured!

I remember clearly how one patient was not responding to treatment as well as expected. On my dusting round I had commented on a picture. Tears came and it emerged that she was worried about her budgerigar. She lived alone in a council flat and had been admitted as an emergency. Obviously no one had noticed the budgie in its cage, and she thought it inappropriate to mention such a 'trivial' thing in a busy hospital. But when we were able to contact a neighbour to budgie-sit for a few days, the lady's recovery was immediate.  That is not something that can be 'quantified'. But it is an essential part of Patricia Benner's nurses' journey 'From Novice to Expert'. It all helps develop the intuitive skills that cannot be taught in the classroom.

I am not anti-technology, but it does seem vital to remind ourselves of the essentials of nursing every once in a while--in whatever area we practice. Nurture and nourishment of the whole person is the essence of nursing. As every branch of nursing relies more on techno-aids to give the best clinical care, I do feel that if we lose the personal, nurturing touch, we might as well go and sell mobile phones.

Florence discovered the importance of good food and hygiene when caring for soldiers in the Crimean War; that principle still holds.

We can tell our patients to have a 'healthy' diet, but do we take the time to look in their fridge (you only have to make a cup of tea and go to the fridge for milk--you don't have to be the fridge police). This shows if food is there--and if it is being eaten, or left to go mouldy. Do we look at a person's mobility? We might do the required 'risk assessment' but do we actually look at the shoes they're wearing--or check they can access the chiropody service? Back in the dark ages of my practice, some older people still had outside loos, and in winter it was just too cold or wet to go outside. So 'incontinence' was diagnosed and pads provided. Resulting UTIs and sore skin became more costly than getting an inside toilet installed, or providing a commode.

Isolation is still rife today, and the social contact of a nurse's visit could be long-term cost effective. One district nurse in Wales told of an elderly man who needed a shave every week as he couldn't lift his arm to shave himself. Then her husband noticed Charley downing a pint in the pub. When she tackled him, he broke down and said she was his only visitor at home, and he couldn't afford more trips to the pub.

I can hear you all crying that these topics 'are NOT nursing'. My question is "why not?" Are they not part of nurturing care? I guess I can answer that—the debate about nursing versus social care has raged since the 1980s. I think the debate now centres on "Can we afford to care?"

Please don't be the generation of nurses who is persuaded not to care.