Tuesday, 20 September 2011

First Do No Harm!

This is the pivotal underpinning of all health care profession learning. We are there to cure, to nurture, and to heal. We are not there to cause pain, harm or suffering and as a nurse, who entered the profession to cause any of the latter? Not me!

By fate I fell into nursing. However, I had always wanted to be a nurse and had a well-developed sense of empathy from a young age. Now however I am struggling: watching the disenfranchised nurses and other healthcare professionals fail in a failing system. I wonder has everyone given up hope and if so why bother coming to work?

We have all dealt with “difficult” patients. The types that don’t conform, don’t comply, don’t fit the boxes and they don’t make our day easy. They challenge us on many levels, exhaust us, insult us and physically and verbally abuse us. They then end up on a merry go round of hospital admissions, sometimes inappropriately and hospital discharges, also sometimes inappropriate. No one wants to draw the short straw to work with “these” people.

However, there is one team that is working with this group of clients. The team operates out of an interface between acute and community and encompasses the complex clients who frequently and inappropriately present to the acute care hospitals. Through pulling a collaborative and client-focused team around each individual they are demonstrating a reduction in inappropriate hospital admissions and emergency department presentations.

In saying inappropriate admissions clients are not excluded from accessing the acute setting, as everyone has a basic right to access healthcare. What is instead focused on is where the best place is to provide the various forms of care required for each individual, and how and who is best placed to manage the client in accessing the care. The traditional silos of various services and health entities operating in isolation is being navigated and permeated, to create an environment of support for the client and for the health care workers.

It is a young team; it is an evolving team and one that is dedicated and passionate. Based originally on the UK Community Matron Model the program also has extended beyond that model to encompass Social Workers in the team to further address the complexity that many in the client group present with. 

Clients come from a hugely diverse background and age range, from those in their 30’s and 40’s right through to octogenarians. 

The system is being challenged on many levels in health and not all are positive, that is the nature of health. However, this small team of which I am privileged to be a part of is challenging it to make a positive impact on many levels, client, systemic, financial and attitudes.

Of all the impacts the team seeks to make, I fear the latter is the hardest one to shift. I watched staff today personalize the acting out behaviors of a chronically ill patient who is dying a slow and difficult death. Their eyes rolled, noses screwed up, sighs were audibly louder than usual, the “not again” comments bounced of the walls. However, in the bed I saw an endearing character that is chronically ill and has had a long-standing history of mental health issues and physical ailments. I saw someone who needed care, compassion and nurturing and unfortunately after an extended period of managing them at home, the right place for their care was a hospital. It is the only place we will be able to facilitate a dignified approach to the end of life care that will be needed to encompass the complex needs that they have.

I fear that the apathy, the cynicism, the disenfranchised are becoming endemic in health care. If workers just stepped back and viewed the situation from a different angle, took a new or novel approach, could they achieve the minutest but most monumental of breakthroughs? Why do they feel infecting everyone around them with the judgmental and detrimental attitudes to these “difficult” clients is productive, beneficial or required? Why do they naively personalize the attacks that the chronically medically and mentally impaired and unwell perpetuate towards them? I don’t have the answers for those questions, but I do set the standard to provide care with a level playing field. In my team everyone deserves a chance to be treated with dignity, to have their situation viewed outside the box that healthcare and professionals have locked them into. It won’t make my day eaiser by taking the path of least resistance and joining the judgment train, I will advocate, I will strive, I will challenge and I will survive long after many of these clients have passed on, hopefully with a dignified death, hopefully with some respect from professionals. I hope; I live, I work another day. These “difficult” clients and the wonderful, dedicated professionals that I am working with inspire me. I am lucky to be me and fall willingly each day into working with complexity.

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