Recently there was some guidance published by the Commission on Improving Dignity in Care which according to certain media suggested that if you called a person you were caring for "dear" it was belittling and you should be sacked. I suspect that this mixing of messages was more to do with journalism than the report itself which says no such thing. Dignity in Care Report.
The report is a sensible (if at times obvious) list of things which in should form the bases for every care home and hospital's approach to working with those in their care. Referring to people obliquely or directly as "bed blockers" or "hip patients" dehumanises the patient and can allow for the instigation of a unintentional abusive relationship between carer and cared for. Often the first stage of abuse is a change in the power structure, with one group starting with power and then increasing it by reducing the power continuously of the weaker group. One simple method of doing this, is to refer to the person by a feature, attribute or condition. None of us wish to be discussed solely as an illness or a personality disorder, we are people with an illness.
Some of the recommendations are astonishingly obvious, but often just don't happen in the day to day running of a hospital or home. As an example, you'd think that training staff to understand dementia is a given, but it so rarely happens even in units that are supposed to be specialists in dementia care. It's all well and good having a senior management team who've got loads of qualifications in dementia, care, understanding behaviour and principles of personalisation, but if you're direct care staff have no idea what they're doing, then it's pointless.
Encouraging relatives and family to feedback and engage in the process is often blocked by organisations who are uncomfortable being scrutinised. It's simple enough to do, it's hard to put into practice without becoming defensive about the service you provide.
However, let's not lose sight of the fact that care staff are also people and need to have some form of coping mechanism in dealing with what can often be a very distressing job. How often does a member of A&E staff have to see a dead child before it has a massive impact on their mental health? How often does a member of staff in an Psychiatric Ward have to see a person with horrific scaring from self harm before they become immune to it? How frequently does an Oncologist have to see a child or adult suffering and intense pain from cancer before they find a way that helps them cope and sleep at night? All of us will use humour as a coping mechanism and medicine is no different, the problem is that this humour rarely translates outside of the job.
The guidance given makes perfect sense, it's succinct (so rare in this day and age of guidance), logical, easily absorbed and most importantly humanises those who might be dehumanised. But, and it's a big one, let's not change demonising patients to demonising those who care for them.
I clearly remember my Grandmother in hospital when she was suffering from cancer being called dear by a nurse. Unfortunately my Grandmother (a formidable woman even at her worse) used to be the PA to the head of Neurology at the Children's hospital so was used to patronising staff. She called the nurse over to have a word with her and when the nurse leaned forward, she stated clearly. "Use my name or get lost, the choice is yours" (long pause) "sweetie".
ReplyDeleteCue much blushing from nurse and a (to her credit) a very good apology and a promise to use her name in future.
Loved my Grandmother :-)