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
Belief
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Film & TV
5 min read

I’m not sure Christopher Nolan has actually read The Odyssey

The director has drunk the Kool-aid of modernity, and done so deeply
the head of a classical statue looks up amid embers around it.
The odyssey poster.
Universal Studios.

Greek myths are full of hubris. Full of it. I feel like ‘hubris’ isn’t a word you hear very often anymore. It means excessive pride or self-confidence that leads to a downfall, in case you were wondering. “Boris Johnson’s hubristic underestimation of the effects of ‘Partygate’ was the final nail in his political coffin,” we might say.  

In one myth, Icarus is imprisoned, but given wings held together by wax in aid of his escape. He is warned not to fly too close to the sun, because the heat will melt the wax. Guess what he does? Yep! Flies too close to the sun. The wings melt and he falls to his death. Hubris

Another myth tells the story of Prometheus. No, not the slightly underrated Alien prequel. (That’s right, I said underrated, but that’s another article for another day). Prometheus defies the Greek gods by stealing fire and giving it to humans. As punishment, Zeus ties Prometheus to a rock and has an eagle eat his liver, only for it to grow back overnight so the eagle can come back the next day and start again. Hubris. 

Greek myths are full of hubris. Full of it. 

And so, this is why I find the new poster for Christopher Nolan’s upcoming adaptation of Greek epic The Odyssey so … bizarre. But then I’ve been nervous about Nolan’s adaptation since it was announced. Nolan is a wonderful filmmaker, but he’s also deeply naturalistic in the messages he conveys. By this, I mean that all his films suggest that nature – the physical, material world of atoms and things – is all there is. Even when he has opportunity to explore themes of the mystical, or magical, or the supernatural, he only does so when a purely ‘natural’ explanation for such things is possible.  

For example, in The Prestige (and HUGE spoilers for the film here: it’s incredible, please watch it if you haven’t), Nolan tells the story of two rival magicians, played by Hugh Jackman and Christian Bale. Robert Angier (Jackman) is trying to work out Alfred Borden’s (Bale) teleportation trick. The secret? (Seriously: big, big spoilers here). Science. Nikola Tesla has invented a device that can clone someone but send the clone to a different location. The trick – the mysterious MacGuffin at the film’s heart – has a natural, scientific explanation. Magic isn’t real and you’re a fool if you think otherwise. 

Perhaps this is also why Nolan directed the wonderful Dark Knight trilogy. After all, Batman’s superpower is just wealth: it’s entirely naturalistic, with nothing that can’t fit into a scientific way of understanding the world. Or we could point towards the science fiction that underwrites Inception, Interstellar, and Tenet. For a filmmaker so gifted at tension and intrigue, he has surprisingly little truck with mystique, mystery, and the divine. But this is a problem when it comes to The Odyssey. A huge problem.  

Let’s return to that poster I mentioned earlier. It shows the head of a classical Greek statue, flames ember underneath it. The caption? Defy the Gods. And it’s at this point I start to wonder if Nolan has actually read The Odyssey. Because The Odyssey takes questions of divinity and their authority very, very seriously. Like many Greek myths and poems, the message of The Odyssey isn’t ‘defy the Gods’. No: it’s ‘trying to defy the gods is an unbelievably stupid, futile, and dangerous thing to do’. Nolan would seemingly have us raze Mount Olympus to the ground.  

Look, all we have is a poster so far. Nolan might prove me wrong. But we shouldn’t be surprised if Nolan reworks The Odyssey in such a way that ‘defy the Gods’ becomes its central message. Because Nolan is a quintessentially modern filmmaker.  

In a 1965 book called Freud and Philosophy, French philosopher Paul Ricœur described the modern period as dominated by a climate of suspicion or scepticism. Within this ‘climate of thought’, the straightforward understandings of things are actually deceptive, instead hiding hidden, deeper, and ‘truer’ meanings. He described Sigmund Freud, Friedrich Nietzsche, and Karl Mark as the ‘masters of suspicion.’ And so the world around us is to be approached suspiciously, to uncover the ‘truer’ meanings about our subconscious (so Freud), our false, religiously imposed morals (so Nietzsche), or our exploitative economic systems (so Marx). 

Each of Ricœur’s ‘masters of suspicion’ might be mapped on to one of the villains in Nolan’s Dark Knight trilogy. Liam Neeson is Ra’s al Ghul, a Freud-like figure who helps Bruce Wayne navigate the psychological effects of his parents’ murders in childhood. Heath Ledger’s mesmeric Joker is Nietzsche’s stand-in, exposing our misguided systems and structures of ethics, tethered to a religious framework we no longer hold to. Tom Hardy’s Bane is Marx, freeing Gotham’s proletariat from the economic structures that oppress them so. 

It's not a perfect fit, but I think there’s more than enough evidence to say that Nolan has drunk the Kool-aid of modernity, and he has drunk so very deeply. And this would be fine – absolutely fine – if he wasn’t planning to adapt The Odyssey. Because, as a quintessentially modern filmmaker, Nolan’s work emerges out of and celebrates a culture wherein ‘defy the gods’ is a slogan that can only be heard as heroic, courageous, and noble, rather than dumb and futile, as The Odyssey would stress to us. 

Defying divinity is not heroic. The Odyssey knows this and knows it well. Defying the gods never ends well for humans stupid enough to try in Homer’s work. Our modern sensibilities encourage us to be suspicious of institutionalised power, especially when that power takes a religious shape. We are predisposed to imagine that invocations of the divine are nothing more than thinly-veiled power-grabs. And sometimes they are. But The Odyssey is right to say that divinity itself is not to be trifled with. Renounce your creator at your peril. 

Like all his other films, Nolan’s The Odyssey is likely to be tense, wrought, and cinematographically immaculate. But also like his other films, I worry it will be deeply naturalistic in the way it handles the inescapably divine and supernatural elements present in Homer’s epic. The Odyssey has an important message for our increasingly hubristic society. I just worry that Nolan’s not the man to convey it as it deserves. 

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