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
Books
Culture
Digital
4 min read

Filterworld: algorithmic anxiety is flattening our culture

The rule of vanilla lets our unfeeling gadgets decide what’s best for us.

Simon is Bishop of Tonbridge in the Diocese of Rochester. He writes regularly round social, cultural and political issues.

A podcast guest speaks in front of a mic.
What's next on the playlist?
Sebastian Pandelache on Unsplash.

Here’s another diagnosis to add to modern malaise: algorithmic anxiety.  It’s described by Kyle Chayka in his excellent book Filterworld (Heligo Books, 2024) as the: 

 …awareness that we must constantly contend with automated technological processes beyond our understanding and control, whether in our Facebook feeds, Google Maps driving directions, or Amazon product promotions. 

We don’t understand algorithms.  Even if we did, we wouldn’t know how they actually work on us as every tech company keeps it a secret, lest competitors learn from them.  This has led to the algorithm becoming the century’s newest bogeyman, a phantom we can reference in conversation to make us sound tech savvy and culturally knowing even while we remain in the dark. 

‘Algorithmic has become a byword for anything that feels too slick, too reductive, or too optimised for attracting attention’.   

Kyle Chayka

One of the oddest outcomes of the ascendency of the algorithm is the seemingly diametric effects on politics and culture.  In politics it has polarised people, sorting us into opposing camps and then ensuring we hear only good things about our ‘side’ and only maddening things about the ‘opposing’ side.  Instead of calmly listening to a different view, we hurl insults, as performative as Prime Minister’s Question Time and about as enlightening. 

Something different is happening with culture.  Here, the algorithm makes culture more homogenous; in the words of Kyle Chayka, it is ‘flattened’.  The basic rule of what he calls Filterworld is that ‘the popular becomes more popular, and the obscure becomes even less visible’.  It is a strange re-mix of Jesus for the digital age: ‘to all those who have, more will be given…but from those who have nothing, even what they have will be taken away. 

The life of an Instagram post is said to be determined in the first five minutes.  If it has engagement, it can be sure of more; if it gets none, it will sink.  Visibility on social media is vital for artists of all kinds, because this is where all publicity begins.  Artists try and game the system, figuring out what kind of content the algorithm will promote.  In the process, their creative expression is subtly compromised.  People begin to write in a style that gets attention, and what gets attention is decided by the algorithm.  Those who tweet will know how the short, pared back medium starts to influence their life away from X. Musicians know that art which is safe and mainstream – the public’s crowded middle where performers like Ed Sheeran have thrived – is likely to succeed.   

‘Much of culture now has the hollow, vacant feeling of having been made by algorithm’ according to the cultural commentator Dean Kissick.  Chayka observes that: ‘algorithmic has become a byword for anything that feels too slick, too reductive, or too optimised for attracting attention’.   

It is often at the margins that breakthroughs emerge; art that makes us see this world in a new and divine light.   

There is a valid counter to this development.  Previously, what we read, heard and saw as cultural consumers was determined by a small set of experts who filtered content for us.  These experts were often drawn from a narrow section of society who inevitably brought their own biases to bear.  While this may be true, it is hardly a triumph for the public to have an unfeeling gadget decide what’s best for them, based on what we have liked before and what seems to appeal to most people.  At the ice cream vendor, this is like reaching for vanilla every time.   

The truth is, in necessarily surrendering to the algorithm (for what alternative is there online?) we miss huge volumes of culture that might appeal to us.  It is about as effective as deciding what sea life we like based only on what pops up to the surface of the water. 

The best art is not always the most popular and there is a risk that the divine spark of invention that the creator God has placed within each of us – the unlimited potential of being made in the image of God – will not be fanned into existence as often as it could be.  Chasing likes is no substitute for patient inspiration.  It is often at the margins that breakthroughs emerge; art that makes us see this world in a new and divine light.   

‘Behold, I am making all things new’ says the one who sits on the throne in Revelation.  That algorithms are making all things similar is the reality we are learning to live with.