What is the role of the nurse? For many of us, the point of nursing is to care for others. This may seem a simple objective but, for nursing in the UK, there is tension between how we define caring and how to maintain this as a primary focus in an increasingly business focused, target-driven organization like the NHS. I would argue the profession needs to go further than a focus on caring: we need to consider what the point of our practice is – what is the goal, what are we striving to achieve for each person we care for?
We need to develop a greater focus on the promotion of wellbeing through seeing illness as a life experience and recognize that this goes beyond the priorities of our organizations or profession and requires us to have the patient experience as our primary consideration.
Caring for wellbeing
What do we mean by wellbeing as a focus for care? Galvin and Todres (2012) offer a view on wellbeing underpinned by a philosophical tradition grounded in the lifeworld-led perspective (Hemingway, 2011); they frame the phenomenon of human caring from the central perspective of “the world of the person” receiving care. This has many dimensions, but its guiding principles focus on vitality, movement and peace. This perspective on wellbeing considers people as having individual potential for creativity and problem solving, even during periods of vulnerability, such as illness. It moves away from dividing wellbeing into social, economic, political, physical and mental domains and focusing on patients as “consumers” of healthcare.
While the current emphasis on patients as consumers and the aspiration for more choice begins to put patients at the centre of care, it does not offer a comprehensive framework or value base for care. Patients can understand their own “journeys” through symptoms or long-term illness better than anyone and, in that sense, each patient is an expert. As professionals we need to acknowledge this without relinquishing our expertise.
However, the way in which we provide care should be guided not only by technical knowledge but also by our understanding of others’ experiences, feelings and stories. Such a partnership approach will support people’s own strategies to improve health and wellbeing and do so in a dignified and respectful way.
Current issues in caring
The NHS is under stress and there is growing concern about its capacity to sustain a high-quality and safe service. Highly publicised failings such as those in Mid Staffordshire Foundation Trust (Francis, 2013; 2010) and in other places have shaken public trust but have not led to a clearresolution. For several years, there has been a sense that “there could be another Mid-Staffs” and that lessons from earlier failings have not been learnt and implemented.
Much of the current government’s term of office has been overshadowed by the long-awaited second Francis report. Undoubtedly, countless health professionals and managers are quietly getting on with changes and innovations that are improving NHS care. What seems to be lacking is any sense of urgency to implement change and innovation on a system-wide basis. Instead, “waiting for Francis” appears have had a paralyzing effect.
