11 Oct 2012
The forthcoming Francis report into events at Mid Staffordshire is likely to provide a salutary reminder of the impact on patients when staff either don't or can't put patients at the heart of what they do, says Bev Fitzsimons, Programme Manager, Point of Care programme.
My work as part of our Point of Care programme has made me recognise that frontline staff often feel powerless to challenge practice in the face of what feels like a monolithic system. Caring for patients makes serious demands on staff – both physically and emotionally. Teams we have worked with have described the unprecedented pressure they face working in today's NHS, with increasing intensity of work, and patients with more complex needs than ever before. They are dealing with illness and distress day in, day out, seeing patients at their most vulnerable.
The impact on health care staff is real. Staff health is poorer in health care than in other sectors, and stress and sickness rates are higher. Unless these stresses are recognised and dealt with, health care staff are at risk of burnout and can become disengaged from their patients. This does not excuse the failings by staff working in Mid Staffordshire, but this burnout and disengagement is undoubtedly a factor we need to consider where the quality and compassion that patients need is lacking.
So what can be done to support staff to provide high-quality care? Most importantly, they must have well-designed roles with good support. Staff can (and many do) cope well with heavy work demands as long as they have good support from managers, good teamworking and a high level of control about how their work is undertaken.
Alongside this it is vital to allow staff time to deal with their own feelings. The Point of Care’s multidisciplinary Schwartz Center Rounds® offers one approach, providing a forum for staff to explore issues related to the emotional challenges of providing care: a multidisciplinary team of staff present the story of a patient they have cared for and then there is a facilitated discussion. Our evaluation has shown that staff really value the Rounds and feel they have a positive impact on their day-to-day work and their relationships with patients and colleagues.
There are other things that can help. Stressed staff groups experience more self-criticism and team conflict; we have delivered workshops to promote resilience among staff. Evidence suggests that focusing on solutions and generating curiosity about how staff manage from day to day – what goes right and why – helps them to be aware of their strengths and the personal qualities and values that sustain them in their work. Many staff who have attended felt that they helped them to reconnect with why they had gone into health care, which can get lost in the relentlessness of the day-to-day work. This can translate helpfully to their relationships with patients and colleagues.
Engaging staff as well as patients is essential to protect the service from the sorts of failures that occurred at Mid Staffordshire and are the key to making change and improvement happen. Organisations with engaged staff deliver a better patient experience and offer better-quality care.
Many health care staff tell us they are surviving, not thriving. Staff stress should be addressed across the system rather than as an individual problem or weakness for the benefit of patients, staff and the system as a whole.
Comments
While waiting for a scan, I saw a very distressed elderly gentleman on a trolley in the waiting room, who was calling out for his wife - and was completely ignored by the nurse who was in the room.
In the social care field we are increasingly pushing the message that the way in which staff relate to the people using the service is one of the most important aspects of quality. If you can do anything to help healthcare staff to understand how important it is that they relate to patients in a kind, friendly and caring manner - you will be doing a great job.
I would put in place on-going regular resilience training (including CBT, mindfulness and compassionate mind training) and embed mentoring and supportive supervision at all levels, as well as leadership coaching. I would ensure that institutions prioritise patient outcomes and quality indicators, as well as the wellbeing of their staff, NOT financial and spurious targets . We need a more systemic approach and a real paradigm shift away from old-fashioned management view of the organisation as machine. I fear that this will not happen in time to avert yet more damage and dehumanisation of vulnerable patients.
Whenever 'why don't nurses seem to really care ?' crops up on the Nursing Times website (and, indeed, often when a case of a nurse having amde a mistake comes up) the standard cry is:
'We don't have enough time - we need more staff !'.
That then moves on to 'nurses are routinely ignored' and 'many of the nurses who move into ward management, instead of fighting our corner for increased staffing levels, seem to just push the senior management line of 'you are not using your time properly''.
I recently posted the following, in an NT piece about 'new money to promote 'caring'':
The first 5 comments aside from mine, in my opinion touch on almost all of the issues for this one.
Judy Mewburn’s comment is the way most aggrieved patients and relatives see the problem: ‘they didn’t really seem to care’ to put it plainly. That isn’t saying that nurses on the whole do not care, or that nurses are not sometimes prevented from ‘caring’ by being over-worked – I said ‘most aggrieved patients’. As I have said before, passengers do not concentrate on the good landings.
There is a fairly widely-held perception, that somehow some of the emphasis on ‘caring’ has been lost, as treatments have become more sophisticated and complex over the years, and as nursing has developed to include things such as prescribing: I am aware that various reports, and NT and many nurses, say the perception is flawed – however, some ex-nurses have expressed the same perception.
When Anonymous | 14-Oct-2012 10:40 am writes ‘The fact that senior nurses are now having to go on a course to learn how to be a decent caring nurse is pathetic and a sign that nurse training/recruitment has gone down the plughole.’ I tend to agree: also, it isn’t 100% clear to me whether the nurses on these courses are there to be taught how to be ‘caring’, or whether they are being taught how to promote ‘caring’ amongst colleagues. Either way, surely the ‘caring’ is so fundamental, that the intention to ‘care’ should be present by the time a nurse qualifies ?
I think this approach, is probably a bit ‘cart before the horse’. I think the right ordering is:
1) Make sure there are enough staff working, for them to have a little time for ‘caring touches’ – at the very least, enough time to not invariably appear ‘brusque’;
2) Make sure that nurses can challenge management diktats that promote ‘non-caring’ without fear of being victimized;
3) AFTER doing the previous two things, so that the working enviroment gives nurses the opportunity to be caring and compassionate, THEN investigate/address any remaining problems re ‘caring’.
At Mid Stafford the nurses got reprimanded severely and the Doctors only got a slap on the wrist.
Spot on - you need to work outwards from the patient !
how can we do better?...
Performance Expectations = Results + Actions & Behaviors
Add your comment