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.  

Review
Culture
Film & TV
Fun & play
Justice
5 min read

Boom! I love this new Superman!

Eschewing ennui, it’s a great fairy tale for the modern age
Superman talks to his dog amid the ice.
Superman and Krypto the dog.
Warner Bros.

…and that’s what makes this film so enjoyable! 

Oh, apologies for any confusion.  

No tortuously ‘relevant’ preamble from me today. I’m starting the review right in the middle of the action, because that is exactly what Superman does. No initial slog through a ‘backstory’ that everyone knows – even my wife, who has never read a comic book in her life, is familiar with who and what Superman is. The closest we get to contextualisation is a quick sequence of text: informing us that Superman landed 30 years ago (adopted by the Kent couple, and given the name Clark), began his superhero career three years ago, stopped the fictional nation of Boravia invading the equally fictional Jarhanpur three weeks ago, and three minutes ago lost a battle for the first time. 

Boom! 

Then straight into the action! 

Superman lands in the frozen tundra of the Antarctic and can barely breathe. He lets out a whistle and the next thing we know there is a tremendous snowy disturbance. Krypto the Superdog dashes into view! No explanation – just delight in the fact that there is a mischievous canine with unbelievable power. Krypto drags Superman ‘home’ to the Fortress of Solitude. There the Superman robots heal him with a concentrated dose of radiation from the Yellow Sun which gives him his power. He immediately departs to continue his bout against the nationalist supervillain ‘Hammer of Boravia’, who is secretly being controlled by the evil genius and billionaire Lex Luthor. 

The pace of this film isn’t fast…its hypersonic. It flies by at the speed of Superman himself. There isn’t any lag, any let up. Even the quieter moments, such as those meditating on Superman’s dual identities (the alien superhero Kal El/Superman and the human reporter Clark) or his burgeoning relationship with investigative journalist Lois Lane, keep the story moving. Exposition doesn’t take place through inexplicable monologues; it is always pacy conversation, which teaches us something about the characters and their relationships and their motivations. 

This is the great triumph of writer/director/producer James Gunn. After his success over at Marvel Studios, he has taken the helm of DC and started to create a universe of characters and stories that doesn’t waste time with painful ‘exploration’ and moralising. This was always the issue that held DC films (arguably featuring the more beloved and well-known characters in comic-book culture) back from matching the success of Marvel. Christopher Nolan is a genius, giving us a superb Batman trilogy, and Zac Snyder produced an underrated dark take on Superman, but neither seemed to delight in the bright, bubble-gum, kaleidoscopic colourfulness of the comic-book medium. 

Gunn refuses to make his Superman film gritty or realistic. Characters appear in all their flash and bombast and are welcomed as cheery additions. The ‘Justice Gang’ are simply there – including the always enjoyable Nathan Fillion with an arrogant smirk and an almost offensive bowl cut. Luthor’s genius allows his to create a parallel dimension…why couldn’t he!? If we can suspend our disbelief to accept a protagonist who is an alien superhero, why not a mini-universe?  

There is none of the former focus on psychological trauma and existential crisis and the sheer overwhelming ennui of being. In previous films the ethical lesson wasn’t just ‘on the nose’…it flattened your nose with a Mike Tysonesque haymaker! Here, Superman simply IS. He IS good. He IS upstanding. He IS fighting for truth and justice. He refuses to allow political and public-relations considerations to corrupt and dilute his absolute commitment to do (and to BE) what is right. One of the most dramatic scenes isn’t a grand battle, it is a quiet moment where Clark allows Lois to interview him as Superman. The more she questions the realpolitik implications of stopping an invasion, the more Clark becomes incensed. How could someone not allow themselves to save innocent life and serve justice to the oppressed against the oppressor? 

The film is such a ‘sigh of relief’ in a bloated comic-book-film market. Yes, the script is hilarious – this is Gunn’s forte. Yes, the music is sublime – both John Murphy and David Fleming’s score (with wonderful nods to the John Williams original) and Mr Gunn’s own needle-drops. The performances are excellent across the board – special mention to David Corenswet, who doesn’t quite look like Superman to me…but boy does he embody the very essence of the character, to the point where you can’t imagine anyone else having played the alien since Christopher Reeve. But its truest strength and victory is its joy in the simplicity (especially moral) of this comic-book genre. 

This is what is so refreshing about Gunn’s vision. Superman IS pure. Lex Luthor (Nicholas Hoult not missing a baldy beat) IS so prideful and vain that it has warped him into something twisted and evil and collapsing in upon his own ego. Watching the film, I was put in mind of C. S. Lewis’ writing on the nature of fairy tales: 

“For in the fairy tales, side by side with the terrible figures, we find the immemorial comforters and protectors, the radiant ones…” 

Comic-books are the great fairy tales of the modern age…why would we make them brooding deconstructions of the human condition, a la Cormac McCarthy? That isn’t their point or purpose. Lewis again: 

“Since it is so likely that they [children] will meet cruel enemies, let them at least have heard of brave knights and heroic courage. Otherwise you are making their destiny not brighter but darker.” 

Gunn has given us a film that isn’t just fun and fluffy, but important. In his sugary, childlike wonder and delight in the genre, he has given us a tale of good versus evil that is a true fairy tale: something gleaming and good, something radiant and right, something attractive and aspirational. Superman is a fairy tale where we can be comforted and emboldened by the moral (nay, ontological!) certainties of love and hope.  

5 stars

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