A good nurse makes little things count

Published on Monday 14 September 2009 20:58

DAY in, day out, there are skilled nurses all over Scotland providing invaluable care to the sick and infirm. Many provide an excellent service, but it would be wrong to grow complacent.

Could nurses be better equipped to carry out their duties? In my experience, both as a nurse and now an academic, the answer is yes. And I have found that it is the "little things" that still really matter.

In a climate where evidence-based practice, value for money, health targets and the patient experience are high on the policy agenda, how do we get it right for every patient?

Nursing is about caring for, supporting and helping patients and those closest to them to cope with their experiences in health, in illness and throughout their life. Patients – quite rightly – want to be treated as people, not a collection of symptoms.

A well-developed body of knowledge for nursing practice is essential, drawing on clinical day-to-day experience, education and research. The experience and outcomes for patients come from how this knowledge is used in practice. If you have experienced good nursing care, you'll remember it.

The nursing workforce is large and diverse, and we won't always get it right. Our collective responsibility is to strive to learn and improve on an ongoing basis.

The interaction between a nurse and the patient and their family is unique and should be two-way. Often it is the little things that are the hallmark of expert nursing practice. This may seem simplistic. However, exploring the little things reveals a complex knowledge base, unique to nursing due to the context of the nurse-patient interaction.

In 1991, I began teaching. It was an innovative post that centred on integrating theory and practice.

However, what we were teaching did not seem to fit with the realities of the clinical world. It was almost impossible to split the practical knowledge – the "knowing how" – and the theoretical knowledge – the "knowing that".

An example comes in the form of a small infusion pump used at the end of life to deliver medication. The medication relieves pain and other distressing symptoms. Being skilled at setting up the pump and ensuring it delivers the appropriate dose is crucial – patients need nurses competent in clinical aspects of care.

However, there is a complex web of other issues. While nurses are comfortable using these devices, it is a new and frightening experience for patients and families. The nurse needs to decide what information to give them and how to alert the family carers as to when advice should be sought, as they will spend many hours alone without nursing back-up.

Proficiency in the task alone, albeit crucial, is unlikely to meet the needs of the people in this example.

A recurring theme is the invisibility of nursing work – nurses find it hard to see anything special in what they do, so the knowledge that underpins nursing practice can also seem invisible.

We are making progress in uncovering the knowledge base of nursing practice. There are currently some excellent examples in Scotland. The Leadership in Compassionate Care Project at Edinburgh Napier University with NHS Lothian ensures that compassion and understanding are embedded in nursing practices, while Connect in Care is a network project to improve the care of older people.

These projects have evolved as more clinicians, and those funding research, recognise the importance of person-centred care and the need to employ methods that actually change the real world of clinical practice.

In a climate where resources are limited and demands on health services are never-ending, it can be difficult for practitioners to bring about significant changes in practice. However, there are many changes, invariably linked to communication and attention to small things, that don't require huge financial resources.

Nurses are critical and central to most, if not all, current health policies. We are becoming better at articulating what we do, but much remains to be done. We need to communicate not only what we do, but also why, and the difference it makes to people.

Illness can have devastating consequences for those affected, and nurses play a crucial role in helping people to deal with these consequences. Recognition of the relationships between what we know, how we do it and what we do for patients and families is crucial to inform policy and practice – ensuring we get it right, or as right as we can, for every patient.

We will make progress if we can link the practice, education, research, management and policy agenda to patient experiences.

&#149 Catriona Kennedy is a professor at Edinburgh Napier University's School of Nursing, Midwifery and Social Care. She will be giving a lecture on this subject on Thursday at 6:30pm, at the Craiglockhart Campus.