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Care
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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.  

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Bled dry: some red flags for those who hope to date a vampire

A philosopher's guide to undying love.

Ryan is the author of A Guidebook to Monsters: Philosophy, Religion, and the Paranormal.

A modern vampire stairs at the face of his girlfried.
Kristen Stewart and Robert Pattinson in Twilight.
Lionsgate.

Writing from his new book, A Guidebook to Monsters, Ryan Stark delves into humanity’s undying passion for all things gothic.  In the first of a two-part series, he asks what is so irresistible about vampires, what do we want from them, and what’s the deal with the armadillos? 

 

Historians point to John Polidori’s The Vampyre as that vital moment in Western vampire lore when the grisly undead creature becomes instead a Casanova. London, 1819. Lord Ruthven, the suave vampire in question, seduces young women and orchestrates chaos in the lives of others—all for his own carnal pleasure. Importantly, he does this by way of persuasion, not rote coercion, which illustrates a key aspect of the modern vampires’ modus operandi. They prefer romance to compulsion, seduction to force. They prefer thrall, almost to the end, at which point the monster fully emerges and the victims fully grasp that their good senses have been compromised. But by then it is too late. 

“None are more hopelessly enslaved than those who falsely believe they are free,” Goethe once observed. Similarly, none are more hopelessly enslaved than those who believe themselves to be dating vampires. 

To resist, however, is easier said than done. Even Buffy the vampire slayer succumbs to thrall, so much so that she invites Dracula to bite her. And he happily obliges, if “happily” is possible in the mind of a vampire. Later, having sobered up from the ordeal, Buffy stakes the villain, but we are nonetheless left with an uneasy feeling. Despite all her experience, despite all her kung-fu knowhow, Buffy still crumbles in the wake of thrall, at least temporarily, putting herself in grave danger and eliciting from us a pressing set of questions. How could this have happened so easily? Will this happen again? Are women attracted to men in capes? 

Much like kryptonite, vampire magic also affects Superman. Two vampires have so far succeeded in hypnotizing him. Crucifer, not fortunate in name, enthralls our protagonist and sends him on several errands, until the Man of Steel has a moment of clarity, as the alcoholics call it, at which point he punches the ancient vampire through the heart. Dracula, too, disguised as an aristocrat named Rominoff, charms our superhero rather easily and then bites him on the neck, only to explode—hilariously—on the premise that Superman’s blood is tinged with sunlight. A moment of dream logic used to subvert the expectation that superblood might somehow benefit the Count. 

Lord Ruthven of Polidori fame also wanders into the DC Comic Book Universe and, per usual, charms his way through problems, until he inadvertently skewers himself on a war memorial. Before this happens, however, we get the strong impression that Ruthven could beguile Superman with ease, if given the chance: that pens are mightier than swords and always have been. 

On the contrary, vampires have a long history of not pointing to Heaven. Instead, they gild the lily. In their attempt to out-gothic the gothic, they turn their style inwardly upon themselves.

Psychoanalysts observe that to empathize with sociopaths is to negate the self most dangerously. They are right, I think, and right—too—that self-erasure proves difficult to recognize at times, because it feels like love. Such is the predicament of those who hope to rendezvous with vampires. Perhaps they have a death wish, some will say, or maybe a savior syndrome, as if they are to save the brooding scoundrels. As if they can. Regardless, the monsters have another plan entirely. As an early church father once explained, those who dine with the devils should bring long spoons. 

Not that vampires are particularly good at banquets. They inevitably exaggerate, like the Macbeths as they welcome King Duncan to the castle: “All our service,” the lady says, “in every point twice done and then done double.”  

Or recall the embroidered hospitality of Bela Lugosi’s 1931 Dracula, caught between silent film and sound: “I bid you welcome,” he says, acting out the part as if the audience must see the motive on his face. A perfect moment when the silent cinema and talking pictures conspire to produce the quintessential vampire ethos, an overstated affectation framed for the modern age. The bow of pretended humility, the elongated gesture, the monumental gravity. The outfit.   

Some speculate that if vampires were able to see themselves in mirrors, they would reconsider their wardrobes. We have reason to think otherwise. Of course, the true gothic is not the vampire aesthetic, because the true gothic always points to Heaven, as in Notre Dame Cathedral, for instance, or Westminster Abbey. On the contrary, vampires have a long history of not pointing to Heaven. Instead, they gild the lily. In their attempt to out-gothic the gothic, they turn their style inwardly upon themselves, incurvatus in se, which signals not grandeur but rather self-apotheosis. In essence, vampires are their own cathedrals, and with this premise proceed accordingly, candelabras in tow. 

If the vampire could only find pleasure in chocolate, if he could laugh with children, if he could be loved like Bella loves Edward in The Twilight Saga, then maybe there is hope enough in the world for all of us.

Longinus, in On the Sublime, uses the term “frigidity” to describe the emotional effect produced by such false grandeur. He means to convey both rhetorical and metaphysical coldness, as does Dante, who places the Devil in a block of ice at the Inferno’s gaudy center. As does Stanley Kubrick, too, who freezes the possessed Jack in the maze at the end of The Shining. And somewhere near the frozen middle of Hell we find the vampires, those who betrayed the strangers in their midst and preyed upon the lonely and the desperate. But now they only devour themselves. We are punished by our sins, not for them. 

On a side note, and concerning the vampire’s many choristers, the opening scene of Lugosi’s Dracula features three armadillos. They wander about the castle and mind their own business, it seems, as wolves howl and spiders weave their webs. On how they got there we do not know, but the armadillos further confirm Longinus’s additional point that the ridiculous and the sublime bear a family resemblance. 

What, then, are we to make of the vampires who sparkle and the vampires with souls? Or, if not in the direction of the dreamy, then in the theater of the absurd: Count Chocula, the mascot for a popular breakfast cereal, or the puppet Count von Count from the children’s program Sesame Street, who teaches viewers how to add and subtract—hitting all the numbers with his heavy Transylvanian accent. We might deem these manifestations too unserious to be taken seriously, but in fairness to the spirit of Count Chocula, perhaps something else happens here. Namely, we find more variations upon the culture-making effort to rehabilitate the demonic, and the almost demonic, as the case might be.  

If the vampire could only find pleasure in chocolate, if he could laugh with children, if he could be loved like Bella loves Edward in The Twilight Saga, then maybe there is hope enough in the world for all of us. Indeed, maybe some vampires have grown tired of being vampires. That said, we do well to heed the old Transylvanian proverb, lest we over-empathize with the villains: the sane would do no good if they made themselves monsters to help the monsters. 

A recent meme depicts the real Dracula in the company of Count Chocula, Count von Count, The Twilight Saga’s Edward, and several other less-than-scary princes of darkness, at which point Dracula laments that the vampires have lost their edge. 

And, true, I have yet to comment on psychic vampires and flaming extroverts, which is an oversight to be sure. As a corrective, and by way of conclusion, I observe the following: for twenty-seven dollars, one can buy a beaker of psychic vampire repellent from Gwyneth Paltrow’s Goop Store in Beverly Hills, California. The Paper Crane Apothecary makes the product, which—with an essential blend of rosemary, lavender, and juniper—protects against the fiends who corner people at parties. At present, however, shipping will be difficult: the website tells me “This item is sold out.” 

  

From A Guidebook to Monsters, Ryan J. Stark.  Used by permission of Wipf and Stock Publishers.