Nursing ‘callousness’? Context is everything..

When I wrote my first post exposing the flaws in the ‘HSMR’ mortality statistics that appeared to identify ‘excess’ mortality at Stafford hospital, and exposing the even bigger flaws in the way that the incorrect conclusions were seized and promulgated by the media and some politicians, I knew I was putting my head above the parapet and was likely to get shot at from some quarters.

It’s been an interesting couple of months since then, with a number of accusations and a fair amount of diatribe coming from certain patients’ groups that were offended that I questioned their position.

Not their personal experiences, but their claims that poor care led to ‘hundreds of needless deaths’ at Stafford hospital (it didn’t), and their wider agenda that has allowed them to be exploited by unscrupulous politicians who find a falsely-damning impression of Mid Staffs a useful weapon to wield against the NHS to justify the targeting and closure of other hospitals.

A lot of this discussion has taken place on Twitter. One of the most constant refrains (apart from the idea that questioning statistics is somehow disrespecting the dead) has been the supposed ‘fact’ that the poor care at Stafford was caused in large part by an ‘uncaring’, ‘callous’ or ‘heartless’ attitude on the part of nurses.

The constant repetition of this leitmotif has fooled some people into demonising nurses at the hospital, leading to numerous instances of verbal and even physical assault against them, with nurses being spat upon and called ‘murderer’ in the street, even in front of their young children. That this is unjustified is something I’ve already written about, and I spent a very moving couple of hours hearing passionate, compassionate nurses relate their experiences through tears.

But every now and then, you read something that so encapsulates the roots of the deeply-misleading portrayal of events at Stafford that it merits additional comment. Today, on Twitter, a member or supporter of the main group claiming to speak for patients and relatives (although after 50,000 or more Stafford people marched last Saturday in support of their hospital and its staff, that claim has to be considered tenuous at best), made the following statement:

 

(Details of the other parties apart from myself out of courtesy)

Anyone who doesn’t know better will look at something like that and be appalled at the thought of what ‘must’ have gone on.

Now, I don’t know which incident she is referring to, and I can’t reply and ask her because she’s blocked me on Twitter (though still including me in her messages!) for questioning ‘her’ group. So I’ll tell you about a couple of incidents about which I do have full details.

Dragging?

Imagine coming into a ward, and you see a young nurse and an elderly patient. The nurse has hold of the old gentleman’s robe and she’s pulling on it and screaming. The elderly man is clearly distressed and very unhappy about what’s been going on, but no matter how much he protests, the nurse refuses to let go of him.

Abuse? Well, hear the context and decide. The old gentleman was in hospital because of lung cancer that had spread to his brain, causing erratic behaviour. Although usually placid and lucid, occasionally he would take it into his head to sprint as fast as his legs would carry him off the ward and out of the hospital.

This behaviour started recently and suddenly, and although he was retrieved safely the first time it happened, if he successfully escaped the ward, he could easily come to harm – perhaps serious harm. The young nurse had seen him start ‘doing a runner’, grabbed onto his robe and was being pulled down the corridor behind him like a water-skier, screaming for other nurses and for security to come and help her prevent her patient leaving the ward and possibly coming to harm.

Within 10 minutes or so, the patient was settled back in his bed, eating his evening meal as if nothing had happened. The nurse, who had put her own safety at risk to protect her patient from himself, was getting her breath back.

Cruel restraint?

Here’s another real-life incident. You enter a side-ward and see a strong young nurse pinning a frail-looking elderly woman’s arms down to the bed. The old woman doesn’t appear to be violent, and she’s pleading with the nurse to let her go, saying she’s hurting her. The nurse refuses to let go, and another nurse in the room ignores the scene and calmly goes about her business.

Abusive? Let’s see.

The old lady was another unfortunate victim of metastatic lung cancer. Cancer cells had gone to her brain, just like they had with the old gentleman. Although cheery and pleasant, the brain tumour could cause her suddenly to lash out – and she had a particular tendency, whenever she needed an injection, of trying to grab the syringe and stab the nurse with it.

The nurses had had a couple of close escapes, and so now they went in pairs to administer injections. One nurse would hold the old lady’s hands down, gently but firmly, while the other gave her an injection, and the whole thing was over in a couple of minutes with no one the worse for it. But to hear the old lady during the procedure, you’d think she was being murdered. Nobody blamed her – she was ill and her brain was affected – but if one of her relatives had entered the room at that precise moment, they might well have been appalled and complained.

Context, context, context

I’ve written before how things that might seem absolutely appalling in one set of circumstances can be regarded as heroism in another. Context is everything, and incidents like the two real-life ones above will be repeated thousands of times a day in hospitals all over the country. They don’t mean anyone is being abused, nor that anyone is being callous – but anyone seeing them without understanding the context (or willfully ignoring it) could easily think otherwise.

The tweet sent by the lady on Twitter who is so angry at nurses and hospitals might relate to a genuine case of abuse or bad nursing. Such things do happen, but they are rare. Far more likely is that any one of a hundred alternative scenarios explains the context of the incident and renders it innocent, or perhaps even brave.

The media and certain politicians are trying to exploit Mid Staffs to help create a new perception of the NHS in the minds of the public. Until this government took office, patient and public satisfaction with the NHS were at record highs, but a popular NHS is much harder to shrink, dismantle or sell off, so there’s a war going on for the minds and hearts of the people as regards the NHS.

The Francis Report into events at Mid Staffs concluded overwhelmingly that poor care, where it occurred (which was in only 3 very busy wards), was caused by serious staffing shortages that led to staff being unable to meet basic needs because of the urgency of immediate, clinical issues – not by callous, uncaring frontline staff.

But you’d never guess that from the ‘response’ of Health Secretary Jeremy Hunt to the report, nor from headlines and articles in a large section of the media.

The tweet from the embittered lady and the ease with which context can be ignored, misunderstood or misrepresented – let alone the stress, emotion, weariness (and sometimes self-recrimination) that they must have been feeling in the heat of the moment – show something very clearly that it’s deeply unwise to simply accept the word of grieving relatives as ‘gospel truth’ when they describe incidents of supposed ‘callousness’.

This is something that we’re being encouraged to forget at the moment by media and politicians with no scruples but with massive ulterior motives. Please don’t.