Wednesday, 29 February 2012

Compassionate Care... Well, Sometimes

Last week, Nicholas had an appointment at the hospital sleep study clinic. Nick has severe apnea and we wanted a current read on how often he stops breathing during sleep. We were to arrive at the hospital with his nurse and an overnight bag at 10:15pm and departure was set for 6:30am the following day. Nick and his nurse were told that someone would collect them in a wheelchair van at about 7:30 in the morning. The week before, the head nurse at Nick's residence had spoken at length to the receptionist at the clinic and informed her of all Nick's special needs.

Fast forward to our arrival at the hospital. A smiling technician greeted us and commented, "Oh, Nicholas is in a wheelchair?" I nodded and asked for the hoist that would work with Nick's special sling. He said that there was no hoist and no one on the unit had any knowledge of Nick's special needs. Without the right hoist, I explained, Nicholas could not be transferred from his chair to the bed. If Nick couldn't lie in bed for the night, the study could not be done. The technician managed to find two orderlies from another department who seemed bemused at having to help lift Nick into the bed. Arrangements for the morning transfer back into the chair were uncertain, but we decided to go ahead and prepare Nick for the test. We settled him into a comfortable position after all the electrodes and leads had been connected and left the hospital around midnight.

The next day, I found out that Nicholas had been asked to leave the unit at 5:30am because that was the preferred time for the transfer out of bed by the orderlies. Nick and his nurse waited two hours in the hospital lobby for their ride. Nick was tired and sore - the hospital mattress had been uncomfortable and sitting is painful for Nick at the best of times.

A couple of days later, I was visiting Nick when I was called to the telephone. It was the respiratory doctor who had ordered the sleep study. He was full of sincere apologies. He couldn't understand how the messages about Nick's special needs were not passed along and he was sorry for the pain and inconvenience caused to Nicholas and his family and carers.

Another mother's blog this week described a visit to an ultra-sound clinic with her daughter that went badly. Those clinic staff were simply surly and refused to assist in lifting this young woman from her chair to the examination table.

Today on my Facebook feed, I noticed a story from the Guardian. Apparently, in the UK, a new report into the treatment of elderly people in care homes recommends that nurses and doctors be hired based on their capacity for compassion as much as for their exam results. Good idea, I thought, but then wondered whether compassion can be measured or tested. So, I googled and found an article on measuring compassion in the Nursing Times. A tidbit from that article:

A new King's Fund report – titled Enabling Compassionate Care in Acute Hospital Services and published this week – also points the finger at a ‘technical shift’, especially in training.

It described core training for the nursing and medical professions as essentially ‘biomedical’, adding that although ‘effective clinical care is clearly fundamentally important… human aspects of care must also be valued in training and in terms of career progression’.

The article went on to offer opposing opinions from gurus within the medical profession as to whether compassion can or should be a recruitment criterion. They all agreed on one point, though. Professionals who are overworked, underpaid and treated with little respect by their superiors are more likely to treat their charges with little compassion or care.

I believe that we should use compassion as a criterion for recruitment and I think a good place to start would be with the senior management. An ethic of compassionate care must come from the top and be expected at every level in the organization, not just for end users. The radical idea of demanding that everyone be very nice to each other is being tried in Alaskan and Australian hospitals (see previous posts on the NUKA model of care). No one in those centres has passed out or died yet from too much kindness.

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