Career advice

Little things count in the fundamentals of care

Loss of control over everyday decisions can make a hospital stay more stressful, says Mandy Day-Calder.
care

Loss of control over everyday decisions can make a hospital stay more stressful, says Mandy Day-Calder

When we had guests staying for the weekend, I was amused when we found ourselves passionately discussing the delicate topic of morning ablutions.

Even among the six of us there were great variations in what was considered normal or acceptable those who shower at least daily were shocked at those who dont and vice versa. I was left pondering over what it must feel like when these choices are taken away from you.

As nurses, it can be hard to remember what an alien environment a hospital is for most people no longer in control of everyday decisions, patients have no choice but to let ward routines dictate the pace and pattern of

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Loss of control over everyday decisions can make a hospital stay more stressful, says Mandy Day-Calder

care
Small acts of kindness can make all the difference.   Picture: Paul Stuart

When we had guests staying for the weekend, I was amused when we found ourselves passionately discussing the delicate topic of morning ablutions.

Even among the six of us there were great variations in what was considered ‘normal’ or acceptable – those who shower at least daily were shocked at those who don’t and vice versa. I was left pondering over what it must feel like when these choices are taken away from you.

As nurses, it can be hard to remember what an alien environment a hospital is for most people – no longer in control of everyday decisions, patients have no choice but to let ward routines dictate the pace and pattern of the day.

Though this may seem like a reasonable trade-off for alleviating pain and distress, we need to remember that patients are often affected by their overall experience of care as well as by its clinical outcome.

Back to basics

What matters to one patient may be different to another. I know that when I am ill I feel so much better if my hair is clean, but for others it may be something else that makes a big difference. So don’t assume that you always know what is best for your patients, and when possible engage in a conversation to see what matters to them.

In 1966, Virginia Henderson famously described nursing as ‘assisting the individual, 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’.

The role of the nurse has changed dramatically since the task-orientated days of the 1960s: you now have to handle complex equipment and balance increasing demands with decreasing resources.

However, you still have a duty to treat people individually. This includes looking after basic care needs which, if not met, can affect overall well-being.

Most important

Since 2015 the Nursing and Midwifery Council code has stressed the importance of delivering the ‘fundamentals of care’ as part of holistic and dignified care. This term is not new – in 2003, the Welsh Government outlined the 12 areas of care which patients (and carers) identified as being the most important:

  • Communication and information.
  • Respecting people.
  • Ensuring safety.
  • Promoting independence.
  • Relationships.
  • Rest, sleep and activity.
  • Ensuring comfort: alleviating pain.
  • Personal hygiene and appearance and foot care.
  • Eating and drinking.
  • Oral health and hygiene.
  • Toilet needs.
  • Preventing pressure ulcers.

Reflecting on this list, can you think of ways to enhance your practice? Sometimes it may just be small changes that make a big difference to those in your care. As Kenneth Schwartz, whose legacy is the Schwartz rounds, said during his illness ‘the smallest acts of kindness made the unbearable bearable’.


Mandy Day-Calder is a freelance writer and life/health coach

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