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Dear Friend of KLICE,

We are pleased to present KLICE Comment.

This month Steve Fouch writes on 'Is there a crisis in nursing care?'

Steve Fouch is Head of Allied Professions Ministries, Christian Medical Fellowship.

When Lord Dilnot produced his seminal commission report into the funding of elderly care in 2011, it is unlikely that he realised that it would come just as a blizzard of reports and news stories came down the turnpike holding up a rather ugly mirror to British society and its attitudes to the most vulnerable members of society.

Prior to that we had had the public enquiry into the appalling failures of care at Mid-Staffordshire NHS Foundation Trust in 2010. Since then stories seemed to come out almost weekly of care home staff neglecting, abusing and humiliating elderly or disabled residents, of hospitals failing to provide adequate care, and undercover documentaries showing uncaring nursing staff ignoring the pleas of their patients.

At the brunt of the outrage over this appalling failure of care standards has been the nursing profession. Once the most respected of all professions, nurses now get regularly bad-mouthed as uncaring 'jobsworths' (I have overheard several conversations at bus stops and train stations strongly expressing this view from people who apparently have experienced this first hand). The professional bodies try to stress that it is poor staffing levels, but over and over people reflect that nursing staff seem to have forgotten what nursing is about.

Is nursing in crisis? Is the health service losing the ethic of care? In a recent CMF Rendle Short lecture, Dr Tim Lyttle suggested that one of the major problems is that we have a health service that is good at transactional care, but poor at relational care. In other words, while on the whole treatment is well delivered and essential services are well provided, the human dimension of care - bringing comfort to the distressed, being aware of and addressing the deeper spiritual and social needs of patients - seems to be increasingly driven to the edges. It seems unquantifiable, so it is not measureable (although plenty of measures DO exist in practice), and thus not seen as a priority.

At the heart of nursing has always been a strong combination of the transactional and the relational, the science and the art of nursing. And this has a lot to do with the historical roots of the profession. Unlike medicine, with its routes in pagan Greece and the brotherhoods of physicians, or the more modern 'allied professions' like Occupational Therapy or Dietetics, with their roots in humanist psychology, sociology or biological sciences, nursing has some very explicitly Christian roots.

The earliest start was with the deacons who were commissioned to care for the vulnerable members of the early church community in Acts 6:1-7 - a role that extended over time to taking in abandoned children who were often left to die at the city gates by families for various reasons: too many mouths to feed, wanting boys rather than girls, or children with obvious disabilities or disfigurement. Later the deacons also took to caring for the sick and dying (also often abandoned on the streets), the disabled and mentally ill and others rejected by society. When the respectable citizens of Alexandria abandoned the city during the plague outbreak in the 4th century, it was Christians that stayed behind, caring for the sick, even though it often cost them their own lives.1

What motivated the early church to do this? A radical new understanding that each and every human being carried the image of God. Not just that we were created in God's image, but that in the incarnation humanity was endowed with dignity at every stage of life. Because Jesus had been an infant, all infants and children were worthy of carrying the image of God. Because Jesus had been a dying man, all dying men (and women) were equally to be valued. The injunctions of Matthew 25:31-46 could not be ignored - and true worship included the selfless care of those too vulnerable to care for themselves.

This carried on into the Western monastic tradition, many of whose orders (male and female) were nursing orders. The Lutheran church in the eighteenth century emulated this through the Deaconess movement, from whom Florence Nightingale received her training in Germany.

While Nightingale wanted to bring scientific rigour to nursing practice, she started with the most basic understanding of compassion and care drawn from a deep faith. One need only read her journals to see her spiritual motivation, or look at her impressive statistical diagrams of morbidity and mortality of her patients in Crimea to see how she readily (and courageously) married the compassionate with the scientifically rigorous.

But in the twenty first century we have begun to leave many of the implicitly-held Christian values and motivations of earlier nursing behind. While values such as care and compassion are still seen as necessary in general, the rationale for them is largely disappearing, and values such as selflessness are seen as positively harmful and to be abjured. The values base is moving away from a selfless focus on the other to a more inward focus on the self. While the emerging generation see caring for family as important, it is at the expense of any sense of wider community or a connection with a transcendent truth through religion. We also see a devaluing of life that is seen as less than perfect - albeit in a sense that it is compassionate to end such lives in abortion or euthanasia. The consequence of all this seems to be a loss of that selfless care ethos in the early church, and a return to something similar to the value base in pre-Christian Roman society.

Dilnot called for society to work out how it collectively cared for its most elderly members. Maybe it is no surprise that the cross-party consensus needed to put this into effect has already broken down. And if nursing as a profession is to regain trust, we need to remember that efficiency and scientific rigour must be wedded to compassionate and selfless care.

1More details on these and other stories of the early church and its role in care and health can be found in Gary B Fengren, Medicine and Health Care in Early Christianity (Johns Hopkins University Press, 2009).

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16:10 09/10/2012