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
AI
Art
Culture
5 min read

Art, AI and apocalypse: Michael Takeo Magruder addresses our fears and questions

The digital artist talks about the possibilities and challenges of artificial intelligence.

Jonathan is Team Rector for Wickford and Runwell. He is co-author of The Secret Chord, and writes on the arts.

A darkened art gallery displays images and screens on three walls.
Takeo.org.

In the current fractured debate about the future development of Artificial Intelligence (AI) systems, artists are among those informing our understanding of the issues through their creative use of technologies. British-American visual artist Michael Takeo Magruder is one such, with his current exhibition Un/familiar Terrain{s} infusing leading-edge AI systems with traditional artistic practices to reimagine the world anew. In so doing, this exhibition pushes visitors to question the organic nature of their own memories and the unsettling notions of automatic processing, misattribution, and reconstruction. 

The exhibition uses personal footage of specific places of renowned natural beauty that has been captured on first generation AI-enabled smartphones. Every single frame of the source material has then been revised, reworked, and rebuilt into digital prints and algorithmic videos which recast these captured moments as uncanny encounters. In this exhibition at Washington DC’s Henry Luce III Center for the Arts & Religion, the invisible work of the AI allows people to experience more than there ever was, expanding both time and space. 

Magruder has been using Information Age technologies and systems to examine our networked, media-rich world for over 25 years. A residency in the Department of Theology and Religious Studies at King’s College London resulted in De/coding the Apocalypse, an exhibition exploring contemporary creative visions inspired by and based on the Book of Revelation. Imaginary Cities explored the British Library’s digital collection of historic urban maps to create provocative fictional cityscapes for the Information Age. 

JE: You are a visual artist who works with emerging media including real-time data, digital archives, VR environments, mobile devices, and AI processes. What is it about the possibilities and challenges of emerging media that captures your artistic imagination? 

MTM: As a first-generation digital native, computer technologies – and the evolving range of potentials they offer – have deeply informed my life and art. Computational media not only opens different avenues for artistic expression but provides a novel means to recontextualise traditional artforms and histories of practice; its ephemeral nature is a particular draw. However, this also creates new challenges, especially in areas concerning preservation and access. I sometimes wonder if my art will still exist for future generations to experience in full, or if it will simply fade alongside the technologies that I’ve used in its production. 

JE: To what extent does Un/familiar Terrain{s} build on past exhibitions like Imaginary Landscapes and Imaginary Cities, and to what extent does it break new ground for you? 

MTM: Un/familiar Terrain{s} certainly arises from and expands on the artistic concepts of those past projects. The main difference is that each artwork in Un/familiar Terrain{s} is generated from a small sample of personal data (a scenic moment that I’ve captured intentionally), not digital materials gleaned from large public archives and online collections.      

JE: Do you find that working with images of the natural world (as is the case with this exhibition) as opposed to images of human-made environments (as you did with 'Imaginary Cities') leads to different approaches or inspiration on your part? 

MTM: My projects that explore constructed environments often reference principles of Modernist architecture and design whereas my pieces in Un/familiar Terrain{s} explicitly seek to dialogue with the long history of Western landscape art. The AI systems that I have used in their creation are leading edge but conversely, their conceptual references extend back to long before the onset of what we consider ‘modern’ art.  

JE: I've heard many artists criticise digital art in terms of degrading the principal tools and techniques of artists throughout history and those arguments would be made even more vigorously in relation to AI. In this exhibition you're enabling a conversation about the painterly effects you can create as a digital artist and those that can be achieved through AI, yet without leading us to one side or other of that argument. Is your vision essentially one of wanting to see the possibilities in whatever tools, techniques or technologies we have to hand? 

MTM: Absolutely. For me that’s one of the fundamental purposes of art. AI is unquestionably the most disruptive (and potentially problematic) technology affecting creative communities at present, but it’s just the most recent historical example. I imagine similar criticisms arose during the proliferation of devices like the printing press and the first photographic cameras. Such inventions clearly did not ‘degrade’ art, but they indisputably shifted its trajectory. 

JE: While your work is not expressly religious, you have engaged with theological themes and institutions as with Un/familiar Terrain{s}, which is on show at Wesley Theological Seminary in Washington DC. What do you think it is about your work and the ways you use and explore emerging media that enables such a dialogue to take place?  

MTM: I feel that many of the social and ethical questions raised by the emergence of transformative digital technologies are quite similar (and sometimes identical) to ones that have been traditionally posed by theologians. With that in mind, although the fields are quite different in many ways, at present there are some strange and compelling intersections. 

JE: From your experience, what can theological or religious institutions learn from a more engaged involvement with emerging media, particularly AI? 

MTM: Like artists, perhaps theologians can use emerging (and disruptive) media to not only expand possibilities for their work, but more importantly, to refocus their efforts towards areas that these technologies cannot presently (and will likely never) address. 

JE: Apocalyptic scenarios are often invoked in response to developments such as AI, the refugee crisis, populist political movements or the climate emergency. In De/coding the Apocalypse, you worked with emerging media to explore contemporary creative visions inspired by and based on the Book of Revelation. From that experience, what advice would you give to emerging artists wanting to engage with or invoke apocalyptic imagery? How might emerging artists live in the shadow of apocalypse or what have you noticed about our contemporary fear of modern apocalypses? 

MTM: Throughout history, visions of apocalypse have been consistently rooted in humanity’s prevailing fears. In the Digital Age these sit alongside our growing concerns about technologies that afford increasingly greater potential to create or destroy. Of course, artists should continue to reveal the deeply problematic (and potentially apocalyptic) aspects of new technologies, but they should also highlight their positive aspects to encourage the creation of “a new heaven and a new earth” that can be a better place for all. 

 

Un/familiar Terrain{s}, 30 May – 18 September 2024, The Dadian Gallery, Henry Luce III Center for the Arts & Religion.