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Thinking Nurse

This blog will reflect my interests in learning disabilities, nursing, nursing theory, philosophy and politics and my general interests in the arts and literature. (Nursing is an art as well as a science!) Philosophy and nursing have been intrinsically linked since the days of Socrates, his mother was a midwife, and taught him everything he knew!

Thursday, December 09, 2004

A Charter For Human Caring In Nursing

Here is a charter for human caring in nursing that I have adapted from something I originally posted on the 'Nursing As Caring' discussion forum, run by Savina Schoenhofer.

Like Savina, I see caring as being a central aspect of nursing, but feel that her theory neglects the political and social life of both patient and nurse, concentrating too closely on an abstract 'nursing moment' that has been wrenched out of any material context.

"It has been argued that there is a paradigm shift toward 'caring' in nursing. The idea that human beings are caring by virtue of their humanity goes right back to pre-Christian thinkers like Cicero - so as a 'paradigm shift' it is a very slow one! It is perhaps really a rediscovery of ideas that were neglected when it looked as if biomedical technologies and techniques had all the answers.It has been shown that every human being seeks inter-relatedness from birth, I think our caring stems from what Peplau called this 'need for connectedness'.

I feel that there are many reasons why nurses do not achieve genuine human caring in their daily practice.

There are so many other things that get prioritised over human caring. Tired nurses in understaffed care environments driven with economic pressures from health bureaucracies, operating in a world full of racial, class, cultural, religious, and gender prejudices can find it incredibly difficult just to BE, one human being with another.

If we are to enable nurses to deliver genuine human caring and human comfort to their patients, then we need to:

1,. Set objectives for nurses that are realistic - I.e. achievable by humans in a human way.

2. Look at all the local and global factors that are obstacles to the delivery of such caring: Are there enough staff for nurses to spend more than a cursory amount of time with their patients? Are adequate resources present, or are staff spending all their time trying to chase basic equipment? Are efforts being made to enable communication between people of different cultures and backgrounds, to overcome all the prejudices that exist in society?

3. Establish an environment where caring is nurtured, rather than having to be fought for by a few brave individuals - what are the priorities of the care environment - targets, profit or human caring?

4. Truly promote human caring in nurse training.

5. Ultimately the care environment cannot be an island, it is directly affected by the values and attitudes of wider society. Societies that prioritise wealth and power and that are uncaring for their weaker or less lucky members are going to be less conducive to human caring in their health professionals - the attitude can become one of just patching people up rather than of truly human healing. Therefore it is neccessary to question these values and attitudes of society that lead to negative health outcomes in so many of it's citizens, and which denigrate the human in all of us.

19 Comments:

At 6:15 PM, Blogger Comrade_Smirnoff said...

So do you think that the NHS follow the Cuban model?

 
At 11:28 AM, Blogger Thinking Nurse said...

A Challenge to The Anarchists

Hi 'Anarchist', and thankyou for posting on my blog.

The 'Charter for Human Caring' I have published here does not advocate a specific model of healthcare provision, more the human values that should motivate it.

I understand that Anarchists, and Marxists would suggest that it is not possible for a healthcare system to be run with such values unless the power of the current global political and economic elite is broken, and a social class with different values takes power instead.

However I am extremely puzzled as to what an Anarchist model of healthcare would look like!

Healthcare requires great material and human resources - buildings, equipment, medications and staff. Managing all these resources is a huge administrative task, and raising the money for the resources is a key political issue.

If you had written more, I imagine, that as an anarchist you feel that Cuban healthcare is run by a bureaucracy that is not accountable to the people. I share this view, though I am impressed by the level of healthcare provision and the remarkable health outcomes that have been achieved in Cuba in the face of the American blockade.

Healthcare institutions here too lack democracy and direct accountability - NHS Trust boards are appointed, not elected, though they handle £millions of public money. The private companies that are used for PFI initiatives are accountable to nobody but their shareholders. These are legitimate issues that nurses, as workers in healthcare should be raising.

Now to my challenge to anarchists: As a thought experiment, let us say that an Anarchist revolution has taken place, the state has been abolished. How will healthcare be delivered?

The facts show that state healthcare systems, free to users are far more efficient than provision by private companies, but the workers in the healthcare industry will still expect to be paid, as will workers in the industries that supply drugs and medical equipment.

In order to raise the revenue for these expenses there will need to be some kind of levy or tax, on wage packets or on industries, and as with all taxes, some people will be reluctant to pay. In order to make sure everybody pays, some form of coercion becomes neccessary. The people charged with this tax-raising coercion, by definition, form a state institution, whichever class they represent, and whether they are elected, appointed or self-appointed.

My challenge to anarchists is to describe a model of healthcare provision that would be able to maintain, or improve on, modern standards of care, and that would not require the existence of some kind of state to raise resources to fund it...

I think this is a very practical question, that Anarchists as advocates of revolution should be able to answer.

 
At 10:40 AM, Blogger Thinking Nurse said...

As an explanatory note, when I first read "Comrade Smirnoff's" comment, he had signed himself as "anarchist" - he has since changed his name. Because he called himself "anarchist", I assumed that politically he must be an anarchist. I now realise that life is not so simple, especially on the internet!

I have had a look at Comrade Smirnoff's blog - it seems to be full of hardline Tankie-Stalinist messages, so he might either be a Stalinist pretending to be an anarchist, or an anarchist pretending to be a Stalinist! It is a very nice looking well produced blog though I find the politics and the Stalinist Kitsch a little hard to swallow.

Either way, my reply to his comment still stands, and my challenge to anarchists to describe how they would organise a healthcare system in a stateless society is still open. I really would be interested to see how it might work.

 
At 4:17 PM, Anonymous Anonymous said...

Hi Max -- I'm not normally a blogger but I'm interested in the question you've raised. I think that an anarchist society -- one that is based on co-operation and communalising resources -- could still have a very efficient and well run health service.

In brief -- allocation of resources and organisation in general can be conducted by mutual consent and horizontally along a network, rather than allocated by political or professional specialists at the top.

Such a network would be run by patients, local residents, as well as the people who work in it -- take the fast disappearing Community Health Councils and multiply them and stick the trades unions in and you'll see what I mean. Self-management is at the core of anarchist ideals, A co-operative run along these lines could exist within a liberal or socialist world as well without the need for an overall 'anarchist society' as well; I think we can agree that the more self-management an insitution involves the better it is, whatever the overall society.

I don't think that people need the incentive of differential wages to want to educate themselves in healing or devote their time to caring. A communist society is one in which everyhing is 'free' and everyone works for 'free' -- there is no means tests, and no metering. For this to work properly, all production and work has to be done within a wider society where everyone is sharing goods and services. Any resources that remain scarce could be allocated by general agreement.

So a well-resourced health care system would involve hubs (clinics, A+E departments, Laing-style communes etc) that existed within a general network of resource sharing -- and I bet that any community/workplace coulcil would have these hubs pretty high on their list of priorities, so these hubs would get all the support they wanted.

These are just a few -- rather utopian -- thoughts. If you want to talk about specifics let me know which ones. Or you could sign up to www.enrager.net/forums or www.u75.org and continue the debate there with the various anarchist thinkers (myself included) who post there.

 
At 10:44 AM, Blogger Thinking Nurse said...

Hi anonymous, and thanks for your considered response.

I think there are a few problems with what you admit is a fairly 'utopian' vision for the delivery of healthcare.

You argue
1. that people would work for free, rather than for cash - in reality they are not working for nothing, but because they know that the community will repay their participation by providing them with the resources they need to live.

One of the justifications for converting to such a cooperative way of living is that people will be economically and socially better off - people will cooperate in such societies providing they will not live in poverty, and that they can be confident that they and their relatives will receive the medical care they need. - The community will still be playing a role of collecting and allocating resources, the fact that they are not cash resources, but physical and human resources does not actually make that much difference to the fact that this is a form of taxation and distribution - a role played by a state.

2. You have argued that decisions will be made by community and workplace councils. This leads to at several problems, at least to people who argue against the existence of state institutions:

a) Who will be responsible for big strategic decisions, such as building a big hospital for a city, or deciding which hospitals should have scanners? These items may well cost far less than aircraft carriers, or an hour of hi-tech warfare, but still require hard decisions about the allocation of considerable amounts of resources. I would suggest that any body given this strategic function would have at least some of the functions of a state.

b) What happens when decisions require upheaval - to build a hospital, it may require people to move from their homes, or change the use of land. What happens when there are groups of people who feel disinclined to cooperate with the decisions reached by these bodies?

(You have seemed to assume that everyone will automatically cooperate through a shared vision of communal bliss - leaving little room for democratic dissension - in a way this is a rather scary picture. Surely there needs to be structures in which parties and oppositions can organise and express their views)

My feeling is that such councils will need to use various techniques of persuasion, in order to establish and assert their authority - from inducement through to coercion, all functions of a state.

If the councils refused to claim and assert authority, resources would not be allocated, and hospitals would not be built. This would be an abnegation of leadership and responsibility, with increasingly dire consequences for people participating in such communities.

This discussion has diverted (due to me really) from a discussion of how to encourage and facilitate caring in nursing, through to a discussion of whether modern healthcare is possible in a stateless society. Anyone wishing to comment further on either issue is welcome to do so. This blog is becoming an interesting forum for a variety of debates and discussions and a whole range of perspectives, far more quickly than I could have expected.

 
At 11:57 AM, Anonymous Anonymous said...

A different anonymous anarchist writes...

The core idea behind anarchism is direct democracy or variants on this idea. The concept is that everyone who will be affected by a decision should have the opportunity to participate in the making of that decision. For councils, read "mass assemblies", and bear in mind that if you have a regular assembly you can hold any appointees to account quite easily.

 
At 5:36 PM, Anonymous Anonymous said...

from raindog

You state
that people providing healthcare in an anarchist community would not be working for free, but rather be working with the expectation that the community as a whole will provide them with the resources they need to live.

i disagree. no doubt some people today enter the healthcare field solely for renumeration (specialists especially), but wouldn't you agree that for most the primary motivation is the desire to aid others? how many healthcare providers do you know who'd pass up a train wreck?
so in our hypothetical anarchist community, healthcare providers would care for their community, and their community would care for them. not on a this-for-that basis is what i'm trying to say. it's not trade...it's community.

you state
The community will still be playing a role of collecting and allocating resources, the fact that they are not cash resources, but physical and human resources does not actually make that much difference to the fact that this is a form of taxation and distribution - a role played by a state.

not an anarchist community you're describing. "from each according to ability to each according to need" (marx wasn't all bad). as a community member, i give what i can and take what i need. no taxation and distribution. no state roleplaying.

you ask
Who will be responsible for big strategic decisions, such as building a big hospital for a city, or deciding which hospitals should have scanners?

you ask
What happens when decisions require upheaval - to build a hospital, it may require people to move from their homes, or change the use of land. What happens when there are groups of people who feel disinclined to cooperate with the decisions reached by these bodies?

you state that your
feeling is that such councils will need to use various techniques of persuasion, in order to establish and assert their authority - from inducement through to coercion, all functions of a state.

it's rather lengthly, but it does answer all of these frequently asked questions (hence the title of 'anarchist faq') here's the section that covers councils.
http://infoshop.org/faq/secI5.html

i recommend you have a look at the rest of the faq too, as you seem to have some misconceptions about anarchism.
http://infoshop.org/faq/index.html

 
At 11:10 AM, Blogger Thinking Nurse said...

Hi, Raindog, thanks for your reply, but please do not refer me to FAQ - this is like asking a Christian why God allowed 150,000 people to die in the Tsunami, and him replying 'look in the bible for the answer'. It may be an answer to the question, but it does not rise to the challenge I have set.

The replies I have had so far state;
1. Things will be decided by mass assemblies - does this mean that the person or group who can draw the biggest crowd will decide what happens? What if those people who did not attend the meeting do not feel inclined to cooperate with it's decision?

2. I am a person who works as a carer, solely out of human kindness. Sorry, I would like to be like this, but if I dont get paid, I dont turn up - I am a product of this capitalist society, and even as an opponent of it's values and it's consequences, I can never fully lift myself fully from where I have come from.
The serious question is how are people to change from the current situation to one where people work selflessly for the good of the community. I do not believe that this can happen overnight, just because a political elite has been deposed. As a materialist I believe that conditions determine consciousness. People who have been inculcated with capitalist ideology from birth are not going to change into fully communist human beings overnight: So what happens in the meantime?

 
At 8:49 AM, Anonymous Anonymous said...

from raindog:

i really have no interest in your challenge. you wanted to know how the councils would work - i referred you to a faq that answers that. faqs are really useful in that they make it possible for people to reduce the amount of time they spend repeating themselves. since i (as an anarchist) spend a considerable amount of time explaining this or that aspect of anarchism, i have found that anarchist faq quite useful. that you did not find it so (or possibly didn't even bother to read the pertinent section regarding councils) is unfotunate. but if anyone else reading this blog did avail themselves of the faq, at least my time spent here wasn't a complete waste.

 
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At 2:37 PM, Blogger Wizbix said...

Good little Blog you have here Max, I thought id take a little look. Hmm, I am also wondering what an anarchist's version of health care would look like ? Are we talking specifically about any particular forms of anarchy or just generally ? I could see hospitals being run well in a syndicalist Anarchistic environment, but would their be an over emphasis on worker action such as the threat of strikes to resolve any issues that come up ?

 
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