Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

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

Awe and wonder

Books

Culture

Poetry

10 October 2024

6 min read

Charles Taylor on how poetry seeks cosmic connections

The philosopher yields an array of luminous insights.

Paul Weston

Paul Weston is a Fellow at Ridley Hall, Cambridge.

At dusk, three people sit on a field edge and look at the stars emerging.

Rad Pozniakov on Unsplash.

Charles Taylor, Cosmic Connections: Poetry in the Age of Disenchantment

At just shy of 600 pages, philosopher Charles Taylor’s latest book is not for the faint-hearted. At the heart of the book are fascinating questions. What kind of language should we use when we encounter ‘beauty’, or experience ‘wonder’ which seems to take us into a new kind of space, or make time stand still? It could be the sight of a breathtaking landscape. It could be a piece of music. It’s that sense of ‘connection’ with something bigger than ourselves. What might it mean? More particularly, how do we express what we intuitively feel to be real and deeply significant about such things when our usual language fails to capture it?

Taylor says that his latest book ‘is about (what I see as) the human need for cosmic connection . . . one shot through with joy, significance, inspiration’. And his hypothesis is that ‘the desire for this connection is a human constant, felt by (at least some) people in all ages and phases of human history’, even if ‘the forms this desire takes have been very different in the succeeding phases and stages of this history’. The book explores these questions by focusing on late-Romantic European poetry and traces its development through the work of later poets including Goethe, Rilke, Wordsworth, Hopkins, and T. S. Eliot.

The background to Taylor’s explorations is the ongoing impact of the Enlightenment on our language and understanding about ‘truth’ and ‘meaning’. Those familiar with his 2007 book A Secular Age will find echoes of it here, particularly the way in which post-Enlightenment language tended to develop the language of control. This, he argues, became increasingly dominant in Western modernity ‘because it is linked to a practical stance which is basically instrumentalist; we seek out the efficient causal relations in our world with the aim of discovering handles which will enable us to realise our purposes’. In reaction to this narrowing of possibilities, the Romantic poets focused on ‘the experience of connection, and the empowerment this brings: not a power over things, but one of self-realization’. And a key element of the Romantic movement was the recognition that a poem (alongside the wider arts) uncovers deeper meanings: it ‘reveals to us, brings us into contact with, a deep reality which would otherwise remain beyond our ken’.

‘Poetry goes beyond creating a mood, an atmosphere of feeling, and claims to give access to the inner force in a thing, not by describing it, but by making it palpable’

Charles Taylor

The book focuses on the variety of forms that this reaction took amongst Romantic poets. A unifying desire for ‘connection’ led to differing ideas about how poetic language makes this possible and what kinds of meaning are revealed. But the central belief remained constant: that poetic language was the key to addressing a prevailing cultural atmosphere of ‘disenchantment’, in which the desire for cosmic connection had been sidelined.

On the English side of the channel, Taylor finds in Keats’ poetry, a new form of expression summed up in his statement ‘Beauty is Truth and Truth Beauty’. In Taylor’s words, ‘Art raises the object to a new unity and intensity, which constitutes Beauty. But this is not something which just exists in the mind of the artist (or reader); it has reality, and hence Truth, even though this reality is partly brought to fruition by artistic (re)creation’.

Similarly, for Gerard Manley Hopkins, the form of poetic language itself can become a means of ‘connection’. As Taylor puts it, in Hopkins’ work, ‘Poetry goes beyond creating a mood, an atmosphere of feeling, and claims to give access to the inner force in a thing, not by describing it, but by making it palpable’. His poetry embodies this in that it ‘renders the rhythms of the being itself through the “sprung rhythm” of the verse’.

The second half of the book looks to poets of the last 200 years who have navigated parallel pathways towards this ideal of experienced fullness – in the face of increasing industrialisation and disenchantment. Baudelaire longs for the experience of fullness, but finds it barred by a state of melancholy that he described as ‘Spleen’. It is a melancholy brought about by the endless repetitions of mundane and urbanised life. Baudelaire’s attempt to find release from our imprisonment in trapped time is to face Spleen head on and to transform it through poetic contemplation.

T. S. Eliot’s poetry similarly aims to evoke the sources of a fuller life in a culture of decay by means of the ‘continual surrender’ of the poet to something more significant and valuable. In Eliot’s case this resolves in a more-or-less traditional sense of Christian order, but Taylor notes that his poetry doesn’t necessarily require this. Miłosz on the other hand, amidst the social and political upheavals in Poland, sought a higher form of poetry: a poetry that could rise above the discord of social turmoil in order to define a moment and clarify the path that needed to be taken.

‘The work of art opens for us a new field of meaning, by giving shape to it’.

Charles Taylor

At times, the weight and detail of Taylor’s exposition threatens to overwhelm the reader, but he offers an array of luminous insights along the way, and he is largely successful in keeping an eye on the broader questions and themes. Perhaps the most important here is his belief that the human desire for ‘cosmic connection’, with its yearning for joy, significance and inspiration is perennial. The book is in this sense an elaborate historical worked example of this desire, understood – perhaps imperceptibly – as a sense of ‘loss’ or ‘longing’. It is this ‘central aspiration of the Romantic period’, he concludes, that ‘remains powerful today’.

My own experiences of talking with people today seems to amply confirm Taylor’s view. And the search for language to describe the desire for this sense of connection (or the longing for it) continues to thrive even within a so-called secularised culture (most likely because of it). It too seeks language for expression and sometimes struggles for some of the same reasons that the Romantics identified. Taylor’s phrase ‘the immanent frame’ (from his A Secular Age) powerfully evokes a sense of being held on a restricted rein, unable to name or explore the realms of ‘beauty’ or the ‘transcendent’ beyond perceived cultural boundaries. Connected to this is the still commonly held belief that any supposed knowledge derived through the arts doesn’t put us in touch with anything other than ourselves.

Taylor convincingly transcends the supposed dichotomy between these so-called ‘subjective’ or on the other hand, ‘ontological’ possibilities. ‘The work of art’, he says, ‘opens for us a new field of meaning, by giving shape to it’. Moreover, it can ‘realize a powerful experience of fulfillment . . . of connection which empowers’. And Taylor backs his theory with autobiography. In Goethe’s ‘Wanderer Nachtlied’, he says, ‘There is a kind of rest/peace which I long for. I don’t fully understand it, but now I have some sense of it’. Or broadening the artistic field, he finds that listening to Chopin’s Fantasie-Impromptu in C sharp minor ‘opens me up to an unnameable longing’, or that when he listens to Mozart’s Jupiter Symphony, he feels ‘a striving upwards, an expression of praise and thanks, straining to reach some higher addressee (for me, this would be God), but I can imagine that someone else, feeling the ascending movement, would imagine another destination’).

Here then is a book that shines a light on the possibilities of ‘cosmic connection’. Taylor affirms our desires, reassuring us that we should not feel strange to share the same longings for ‘fullness’, for ‘transcendence’, for ‘joy’ and for ‘connection’ as did the Romantic poets. Our recognition of these desires may well have been evoked by the kind of poetry or music that Taylor talks about here. But for all of us, it is good to be reminded that in a western world still heavily influenced by the climate of secularisation many today are still searching for the sense of cosmic connection that Taylor describes.

Charles Taylor’s Cosmic Connections: Poetry in the Age of Disenchantment is published by Harvard University Press.