Article
Care
Change
6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient
Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care.   Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions? 

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.  

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers. 

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.  

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired  infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’. 

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care. 

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?” 

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. 

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.” 

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.  

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.  

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”    

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.  

Article
Character
Comment
Friendship
Virtues
6 min read

Guiding’s new badges don’t deserve this media criticism

Encouraging interests builds character now and for tomorrow

Paula Duncan is a PhD candidate at the University of Aberdeen, researching OCD and faith.

Two Brownies point out their badges.
Girl Guiding.

As a Brownie leader, what I love about Girlguiding is the perfect blend of tradition and modernity. Lots of people will have memories of belonging to Brownies or Guides. In conversation, it’s often the uniforms that people mention first – for ex-Brownies it’s always the brown dresses, or the iconic yellow sweatshirt which has now been relaunched for adults as a retro range. I will admit to buying one almost immediately and have loved wearing my tribute to the Jeff Banks design era of uniform that I loved so much as a child.  

For those unfamiliar with the organisation, Girlguiding began in 1909 with a small group of girls who joined a Scout rally and bravely asked that there be ‘something for the girls’ too. Today, Girlguiding has four youth sections: Rainbows (aged 4-7), Brownies (7-10), Guides (10-14), and Rangers (14-18).  

I’m particularly excited to go back to our weekly meetings after the school holidays because a new range of interest badges have just been launched for all sections – 78 in total! These badges are designed so that girls can choose which activities they’d like to pursue – either a new skill or hobby or learning something new. Each badge fits into one of our six distinct programme areas: Be Well, Express Myself, Skills for My Future, Take Action, Know Myself, and Have Adventures.  

A lot of the publicity surrounding the badges has been really positive – praising the organisation for representing the interests of young people. The badges were designed, after all, with the input of members and with extensive testing by groups across the UK, and feedback from 11,000 girls about the new badge offerings. My Brownie unit enjoyed being part of the testing pool for the ‘Passions’ badge, which encouraged them to think more deeply about the hobbies they have and try some new pursuits. Reading the final version of the badge when it was released was brilliant because I could really see the impact of the Brownies’ feedback.  

I’ve been disappointed to see the organisation’s new badges be subject to some heavy media criticism and that headlines have been tailored to mock, rather than share the relevant and interesting content that the badges actually offer. The Telegraph used the current tensions around gender identity to create a clickbait title: “Girlguiding ‘hostess’ badge gets gender-neutral makeover” which, inevitably, caused a flurry of (largely unpleasant) Facebook comments about identity politics. While the article itself does well to describe some of the new badge offerings, leading with a controversial heading detracts from the truth that the previous ‘hostess’ badge was discontinued as part of the programme refresh and that member feedback brought about a return of a similar offering.  

Victoria Richards writes in The Independent that: ‘Girlguiding is […] modernising the way it interacts with young people. Speaking their language. After all, what use is an organisation for girls if nobody wants to join it?’  

This does not seem to be the opinion of Lucy Mangan who writes a particularly scathing indictment of the movement in general and in a large part advocates for teaching children how to use a gun and cut down trees. Obviously unfamiliar with the Girlguiding programme, she misses that our new interest badges are just that – part of a programme that encourages girls to pursue their own interests and often to try something new! “Interest” simply means that we allow girls to choose for themselves what they are interested in learning more about. We remain dedicated to teaching core life skills (things like first aid, I’d argue, rather than using a gun) as part of the Skills Builder set of badges that progress through each section.  

An opinion piece in The Express says: ‘The new Girl Guide badges are so easy, it’s like awarding a gold star for blinking’… This simply isn’t true; even the youngest members are encouraged to try something new or improve on a skill. It’s strange that none of these critical articles come from current members or leaders. Sometimes we do offer badges for participation at an event or marking on occasion but part of the joy of those is collecting them. I love looking for a badge patch when I’m on holiday and adding them to my camp blanket. There are some fantastic blankets out there – with badges from people’s travels, awards they’ve earned, and badges they’ve swapped with others they’ve met at events.  

Why shouldn’t we be encouraging our youngest members to have courage?

Most articles – including the BBC – have chosen to lead articles with the range of badges that fall under ‘Be Well’ or ‘Know Myself’ and are therefore designed to help young people learn valuable skills in self-care and identifying the things that are important to them. They are, by nature, designed to help young people learn more about themselves and how they interact with the world.  

This leads readers to believe that all badges are ‘self-centred’ as critics like Mangan have written. Why shouldn’t we be encouraging our youngest members to have courage? Girlguiding’s research has shown that 50 per cent of girls surveyed felt anxious about their future in 2024. Showing girls how to manage feelings of worry from a young age can only be a good thing. Our Rainbows are encouraged to “share the laughter with someone else.” Brownie Guides are working on their friendship badge are asked to “spend time with a new or old friend”.  

Dig a little further and look to the other interest badges and there can be no doubt that the programme Girlguiding offers is important and helps young people to challenge themselves and build new skills. The activities offered are relevant to the concerns of young people and the betterment of their communities. Rangers are supported to learn more about voting and how to ensure their voice is heard. In a world with fast fashion and markets like Temu dominating digital spaces, Guides can find out how to make informed decisions as part of their Conscious Consumer badge. 

Brownies can learn new languages or work towards their Mechanic badge. Even the youngest girls have the chance to learn about key principles of architecture in their Construction badge – the full syllabus of which is online. For critics who say that traditional skills like knot tying, sewing, or semaphore are forgotten by Girlguiding, all of these can be found in our Skills Builders and unit meeting activities. It can be so easy to be critical of something new or something that is changing without doing any further research to find out whether the headlines are accurate. Clickbait headlines are designed to drive up traffic and revenue, but something of the truth is lost in the process.  

I am incredibly proud to be part of an organisation that offers a rich, varied programme to young people. It has helped me grow from an anxious primary school child to a leader who can recognise the value of teaching life skills that are relevant to our time and place. Right now, girls need to have the resources and support to thrive in both the tangible world, and in an increasingly digital world.  

For those disheartened by the reception of the new badges, it’s worth looking to smaller news outlets. Those who have taken the time to garner responses from members and young people are much more encouraging and help to celebrate an exciting new step in our programme. I hope that those who can see the value of the programme offered to girls through Girlguiding can use this opportunity to find out more. If anything in this article has resonated with you, please do check out volunteer opportunities. 

From someone who likes to incorporate things like Star Trek into my academic work, why shouldn’t we be able to offer a badge about Fandoms? Why shouldn’t we celebrate the things that we enjoy? There really is something for every girl, even if the loudest voices in Facebook comment sections don’t make that clear. I’m incredibly proud to be part of an organisation that brings out the best in young people (and in me as an adult leader!).  

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