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
Culture
Film & TV
Paganism
5 min read

Kaos shows why we might think twice before inviting the old gods back

The illusory glamour of Olympian gods titillates us once more.

Theodore is author of the historical fiction series The Wanderer Chronicles. He previously studied Dark Age archaeology at Cambridge, and afterwards worked in international law.

A mock classical ceiling painting depicts modern version of the classical gods.
Ye gods above.
Netflix.

The old gods are making a comeback all across Western culture. This is a conclusion increasingly reached by a spectrum of culture-watchers; some religious, some not at all. But, if true, the boldest and brashest example of this comeback may well be the new Netflix series KAOS, starring Jeff Goldblum, released last month.  

Kaos is a genre-busting mythological dark comedy-drama. One might say a modern re-summoning of the pagan gods.  

Charlie Covell, the writer and mastermind behind the show, and a self-confessed mythology geek, has created a colourful, high production, and often funny depiction of what the world might be like if the gods of Olympus still ruled over us. The plot follows several different strands taken from Greek mythology - most obviously Orpheus’s journey into the Underworld to bring back his dead wife, Eurydice - and weaves them together into a larger narrative, retelling the downfall of the gods. 

As the show opens, Zeus reigns as king of the gods from his fantastically kitsch mansion atop of Mount Olympus. So long as the sacrifices and adulation of humankind keep rolling in, he is happy. But when he wakes one day to discover a new wrinkle on his forehead, this triggers not only a kind of mid-life crisis, but also possibly - so he fears - the end of the world as he knows it.  

Goldblum plays Zeus as, well, Jeff Goldblum: quirky, nervy, paranoid, and not a little menacing in an understated way. In other words, perhaps more “Jeff Goldblum” than you’ve ever seen him on screen before. It is certainly a compelling and sometimes hilarious portrayal.  

“A line appears, the order wanes, the family falls, and Kaos reigns.”  

This is the prophecy that has haunted Zeus for aeons. What he doesn’t know is that he shares this personalised prophesy with three other mortals in the story - Eurydice (Aurora Perrineau), Caneus (Misia Butler), and Ariadne (Leila Farzad) - all of whom will play an unwitting role in bringing about the overthrow of the world order under the Olympian gods (hence: KAOS). The early episodes establish who these mortals are and begin to draw their disparate stories together.  

Counterpoint to Zeus is his brother, Hades, ruler of a literally black-and-white underworld, with David Thewlis brilliantly cast in the role as the world-weary and ailing keeper of the realm of the dead. Something is amiss down there which threatens the whole system of human souls and what happens to them. When he tries to warn his brother, Zeus’s disdain for Hades and his problems only makes matters worse. Also in the frame of this dysfunctional family are Hera (Janet McTeer) and Poseidon (Cliff Curtis) - brother and sister (and wife in Hera’s case) to Zeus, as well as being lovers behind his back, who are poised to put into effect their own betrayals, if Zeus goes too far off the rails. 

Last, but not least, since he proves the bridge between the gods and humans is Dionysus (Nabhaan Rizwan), one of Zeus’s many children. (But the only one who comes to visit.) A hedonistic agent of chaos from the outset, Dionysus seems to be the only one of the gods with any genuine interest or admiration for humans. Impressed by rock-star Orpheus’s passionate love for his wife, Eurydice (“Riddy”), it is Dionysus who helps Orpheus break into the Underworld to get her back when she dies, thus triggering the series of events that could let to the fulfilment of the prophesy. 

The illusory glamour of the gods of Olympus seem to titillate us once more. We don’t really believe in them, but we’d kind of like to see more of them all the same.

Smart, stylish, twisty and certainly original - (the entrance to the Underworld is through a dumpster bin around the back of a bar) - Kaos is an ambitious multi-stranded epic about power, fate, love, and family. But perhaps above all, it is saying something about the relationship between humanity and the divine. At one point, one mortal tells another that the only good things in life are human. This feels like a statement of underlying intent. And the way the gods (especially Zeus) become more capricious, more sadistic, more vengeful as the story unfolds, the more it feels like we’re encouraged to agree. Defiance of the gods is the real mark of virtue here. Rebellion against the gods, the natural outworking of that defiance. 

The irony is that whatever distaste which Kaos succeeds in cultivating in us, the viewer, for pagan forms of the divine may help explain why, historically, Christianity swept aside all the pantheons of pagan worship of the first millennium in the wholesale way that it did. Jesus Christ literally incarnates that bridge between the divine and the human. And what’s more, the message he preached claimed that, far from disdaining humanity, God loves them so much that he was willing to be the sacrifice for their good. And not the other way round, demanding incessant and capricious sacrifice by humans instead.  

Now, centuries later, in Western culture, familiarity seems to have bred contempt with that far more hopeful story. Instead, the illusory glamour of the gods of Olympus seem to titillate us once more. We don’t really believe in them, but we’d kind of like to see more of them all the same. And storytellers like Charlie Covell are only too willing to give the public what they want. If the old gods are indeed trying to make a comeback, Kaos shows us why we might think twice before inviting them in.  

Does Kaos succeed? It certainly makes a valiant attempt to marshal a large number of plot lines involving a huge cast of characters, unfortunately not all of whom are interesting enough to keep you coming back for more. And an awful lot is riding on there being a Season 2 - that is, if the threads we have followed so far are to lead on into a satisfying and meaningful conclusion.  

Without that, I’m afraid the whole thing may be left standing alone as a work of, well… chaos.