Nursing Care BD

What is good health?

Biswas — Mon, 09 Nov 2020 10:39:21 +0000

According to the Centers for Disease Control and Prevention (CDC), healthcare costs in the United States were $3.5 trillion in 2017. However, despite this expenditure, people in the U.S. have a lower life expectancy than people in other developed countries. This is due to a variety of factors, including access to healthcare and lifestyle choices.

Good health is central to handling stress and living a longer, more active life. In this article, we explain the meaning of good health, the types of health a person needs to consider, and how to preserve good health.

What is health?

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Regular exercise contributes to good health.

In 1948, the World Health Organization (WHO) defined health with a phrase that modern authorities still apply.

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

In 1986, the WHO made further clarifications:

“A resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.”

This means that health is a resource to support an individual’s function in wider society, rather than an end in itself. A healthful lifestyle provides the means to lead a full life with meaning and purpose.

In 2009, researchers publishing inThe Lancet defined health as the ability of a body to adapt to new threats and infirmities.

They base this definition on the idea that the past few decades have seen modern science take significant strides in the awareness of diseases by understanding how they work, discovering new ways to slow or stop them, and acknowledging that an absence of pathology may not be possible.

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Mental and physical health are probably the two most frequently discussed types of health.

Spiritual, emotional, and financial health also contribute to overall health. Medical experts have linked these to lower stress levels and improved mental and physical well-being.

People with better financial health, for example, may worry less about finances and have the means to buy fresh food more regularly. Those with good spiritual health may feel a sense of calm and purpose that fuels good mental health.

Health inequities affect all of us differently. Visit our dedicated hub for an in-depth look at social disparities in health and what we can do to correct them.

Physical health

A person who has good physical health is likely to have bodily functions and processes working at their peak.

This is not only due not only to an absence of disease. Regular exercise, balanced nutrition, and adequate rest all contribute to good health. People receive medical treatment to maintain the balance, when necessary.

Physical well-being involves pursuing a healthful lifestyle to decrease the risk of disease. Maintaining physical fitness, for example, can protect and develop the endurance of a person’s breathing and heart function, muscular strength, flexibility, and body composition.

Looking after physical health and well-being also involves reducing the risk of an injury or health issue, such as:

minimizing hazards in the workplace
using contraception when having sex
practicing effective hygiene
avoiding the use of tobacco, alcohol, or illegal drugs
taking the recommended vaccines for a specific condition or country when traveling

Good physical health can work in tandem with mental health to improve a person’s overall quality of life.

For example, mental illness, such as depression, may increase the risk of drug use disorders, according to a 2008 study. This can go on to adversely affect physical health.

Mental health

According to the U.S. Department of Health & Human Services, mental health refers to a person’s emotional, social, and psychological well-being. Mental health is as important as physical health as part of a full, active lifestyle.

It is harder to define mental health than physical health because many psychological diagnoses depend on an individual’s perception of their experience.

With improvements in testing, however, doctors are now able to identify some physical signs of some types of mental illness in CT scans and genetic tests.

Good mental health is not only categorized by the absence of depression, anxiety, or another disorder. It also depends on a person’s ability to:

enjoy life
bounce back after difficult experiences and adapt to adversity
balance different elements of life, such as family and finances
feel safe and secure
achieve their full potential

Physical and mental health have strong connections. For example, if a chronic illness affects a person’s ability to complete their regular tasks, it may lead to depression and stress. These feelings could be due to financial problems or mobility issues.

A mental illness, such as depression or anorexia, can affect body weight and overall function.

It is important to approach “health” as a whole, rather than as a series of separate factors. All types of health are linked, and people should aim for overall well-being and balance as the keys to good health.

Find out how mental health can affect physical health here.

Factors for good health

Good health depends on a wide range of factors.

Genetic factors

A person is born with a variety of genes. In some people, an unusual genetic pattern or change can lead to a less-than-optimum level of health. People may inherit genes from their parents that increase their risk for certain health conditions.

Environmental factors

Environmental factors play a role in health. Sometimes, the environment alone is enough to impact health. Other times, an environmental trigger can cause illness in a person who has an increased genetic risk of a particular disease.

Access to healthcare plays a role, but the WHO suggest that the following factors may have a more significant impact on health than this:

where a person lives
the state of the surrounding environment
genetics
their income
their level of education
employment status

It is possible to categorize these as follows:

The social and economic environment: This may include the financial status of a family or community, as well as the social culture and quality of relationships.
The physical environment: This includes which germs exist in an area, as well as pollution levels.
A person’s characteristics and behaviors: A person’s genetic makeup and lifestyle choices can affect their overall health.

According to some studies, the higher a person’s socioeconomic status (SES), the more likely they are to enjoy good health, have a good education, get a well-paid job, and afford good healthcare in times of illness or injury.

They also maintain that people with low socioeconomic status are more likely to experience stress due to daily living, such as financial difficulties, marital disruption, and unemployment.

Social factors may also impact on the risk of poor health for people with lower SES, such as marginalization and discrimination.

A low SES often means reduced access to healthcare. A 2018 study in Frontiers in Pharmacology indicated that people in developed countries with universal healthcare services have longer life expectancies than those in developed countries without universal healthcare.

Cultural issues can affect health. The traditions and customs of a society and a family’s response to them can have a good or bad impact on health.

According to the Seven Countries Study, researchers studied people in select European countries and found that those who ate a healthful diet had a lower 20-year death rate.

The study indicated that people who ate a healthful diet are more likely to consume high levels of fruits, vegetables, and olives than people who regularly consume fast food.

The study also found that people who followed the Mediterranean diet had a lower 10-year all-cause mortality rate. According to the International Journal of Environmental Research and Public Health, this diet can help protect a person’s heart and reduce the risk of several diseases, including type 2 diabetes, cancer, and diseases that cause the brain and nerves to break down.

How a person manages stress will also affect their health. According to the National Institute of Mental Health, people who smoke tobacco, drink alcohol, or take illicit drugs to manage stressful situations are more likely to develop health problems than those who manage stress through a healthful diet, relaxation techniques, and exercise.

Preserving health

The best way to maintain health is to preserve it through a healthful lifestyle rather than waiting until sickness or infirmity to address health problems. People use the name wellness to describe this continuous state of enhanced well-being.

The WHO define wellness as follows:

“Wellness is the optimal state of health of individuals and groups. There are two focal concerns: the realization of the fullest potential of an individual physically, psychologically, socially, spiritually, and economically, and the fulfillment of one’s roles and expectations in the family, community, place of worship, and other settings.”

Wellness promotes active awareness of and participating in measures that preserve health, both as an individual and in the community. Maintaining wellness and optimal health is a lifelong, daily commitment.

Steps that can help people attain wellness include:

eating a balanced, nutritious diet from as many natural sources as possible
engaging in at least 150 minutes of moderate to high-intensity exercise every week, according to the American Heart Association
screening for diseases that may present a risk
learning to manage stress effectively
engaging in activities that provide purpose
connecting with and caring for other people
maintaining a positive outlook on life
defining a value system and putting it into action

The definition of peak health is highly individual, as are the steps a person may take to get there. Every person has different health goals and a variety of ways to achieve them.

It may not be possible to avoid disease altogether. However, a person should do as much as they can to develop resilience and prepare the body and mind to deal with illnesses as they arise.

The post What is good health? appeared first on Nursing Care BD.

What is Personal Care?

Biswas — Mon, 09 Nov 2020 10:34:02 +0000

Personal care in the home is a very broad term used to describe a number of different areas of care and support a carer will provide, and includes:

Bathing and showering

Our carer will ensure that you are able to enjoy a much-loved bath again, with your chosen relaxing bath products or regularly take a shower, whilst providing you with the physical support and comfort you need.

Dressing and getting ready for bed

We appreciate that this routine task can become challenging as we get older, but with the discreet support and gentle encouragement from a personal assistant, means you no longer need to be as concerned about this each day.

Foot care

Our carer will ensure your nails and feet are tip top! They will monitor your needs to ensure your nails are well maintained, feet are cared for including providing relaxing pedicures and, if you are diabetic and need more specialist care, our professional carer will ensure a robust regime of quality foot care in partnership with local chiropodists.

Hair and beauty

We know how important it is for self-esteem for you to maintain your personal appearance. Our professional carer will ensure your hair is clean and styled to your personal preference, whilst arranging for visits from a home hairdresser or facilitating a trip to the hairdressers for treatments and cutting. Carers will support you to continue to wear your make up and enable you to shave, just as you always have.

Oral hygiene

Nothing is more important than oral hygiene as we get older to minimise infections and maintain healthy teeth and gums. Our carer will support you to maintain excellent daily oral hygiene, whilst facilitating regular visits to the dental practice or visits from the dentist at home.

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What is patient care?

Biswas — Mon, 09 Nov 2020 09:07:02 +0000

Patient care refers to the prevention, treatment, and management of illness and the preservation of physical and mental well-being through services offered by health professionals. Patient care consists of services rendered by health professionals (or non-professionals under their supervision) for the benefit of patients. A patient is a user of health care services whether he or she is healthy or sick.

What are the issues and how are they human rights issues?

Patients are entitled to the full range of human rights. Health care providers must respect each patient’s dignity and autonomy, right to participate in making health care decisions, right to informed consent, right to refuse medical treatment, and right to confidentiality and privacy. The attention, treatment, and care that each health care provider gives to a patient must respect the human rights of every one of his or her patients.

The human rights-based approach to patient care draws from standards contained in the international human rights framework, which are often mirrored in regional treaties and national constitutions. It differs from patients’ rights, which codify particular rights that are relevant only to patients. Human rights standards apply to all stakeholders in the delivery of health care—including both patients and care providers.

A human rights-based approach seeks, above all, to uphold the inherent human dignity of all actors in the care provider-patient relationship. This relationship can be a complex one, especially when coupled with health care delivery. For example, as medicine becomes ever more advanced, providers and patients must work together to make diagnostic and therapeutic decisions. Financial and quality issues are always present in health care delivery and can lead to inequality and discrimination. Greater understanding is needed of the social determinants of health that straddle the lines between traditional medicine and a broader concept of health, as well as of the interdependence of the right to health and the realization of all human rights.A human rights-based approach uses the human rights framework to analyze these elements of patient care, among others.

Below are some common human rights issues that arise in patient care settings. This list is not comprehensive. The list alternates between highlighting issue areas and highlighting marginalized groups whose human rights are frequently violated in the health care setting.

Right to information

Patients are often unaware of their rights, including the right to information on their condition and the right to access their medical records. In a study conducted at four hospitals in Lithuania, 85% of the staff and 56% of the patients surveyed had heard of or read about patients’ rights laws. Moreover, only 50% of professionals and 69% of patients thought it was necessary for patients to have information about diagnosis, treatment results, and alternative modes of treatment. Another study in Macedonia found that 82% of respondents stated that there are patient rights, but 56% did not know what their rights were.

Patients have the right to information about their health status, treatment options and reasonable alternatives, and the likely benefits and risks of proposed treatment and non-treatment. Patients also have the right to access their medical chart and medical history.

Right to privacy and confidentiality

Patients have the right to have their health information and data kept confidential. According to Gostin et al., “Health data may include not only a patient’s sensitive health status, but also those facts or circumstances that the patient reveals to [health care workers] as part of seeking medical treatment.” The “right to privacy and confidentiality must be applied sensitively, with respect for different cultural, social, and religious traditions.”

For certain vulnerable groups, the right to privacy and confidentiality is an essential aspect of obtaining health care. For example, privacy and confidentiality are crucial to realizing sexual and reproductive rights for women and adolescents. In General Comment 14 on the right to health, the Committee on Economic, Social and Cultural Rights states that “[t]he realization of the right to health of adolescents is dependent on the development of youth-friendly health care, which respects confidentiality and privacy and includes appropriate sexual and reproductive health services.”

Privacy and confidentiality are also crucial for patients seeking diagnosis and treatment of illnesses with which stigma is attached, such as HIV/AIDS and mental illness. Depending on the type of care an individual is seeking, some health care centers may only allow specific providers to access the patient’s health information. For example, a nurse who is vaccinating a patient may not access that individual’s private mental health records because the information is not relevant to the treatment being provided at that current moment.

The right to confidentiality of health information should not interfere with the right to access of private health information. While a holder of private health information should be prohibited from sharing that information with anyone who is not essential to providing health care to the individual, the holder must provide the individual access to their private health information upon the individual’s request. Patients have the right to access their own health information, to be able to control how the information is shared with them (for example, being able to indicate to where mail or phone calls are directed), and to be able to authorize the disclosure of information when desired. The right to confidentiality of private health information, as well as the right to accessibility of private health information, should be upheld and not compromised in respecting the rights of the patient.

Right to informed consent to treatment

The UN Special Rapporteur on the right to health, Anand Grover, defines informed consent as the following:

Informed consent is not mere acceptance of a medical intervention, but a voluntary and sufficiently informed decision, protecting the right of the patient to be involved in medical decision-making, and assigning associated duties and obligations to health-care providers. Its ethical and legal normative justifications stem from its promotion of patient autonomy, self-determination, bodily integrity and well-being.

The right to informed consent is central to the right to health. Issues that arise concern the competency or legal capacity of the patient to consent, respect for personal autonomy, the sufficiency and completeness of information, and circumstances compelling limits on the need for informed consent.

The complexity of informed consent is mirrored by patients’ lack of understanding of its meaning and importance. For example, in a 2006 study of 732 European surgical patients in obstetrics and gynecology during a six-month period, about 46% believed that the primary function of the written consent form was to protect the hospital, and 68% thought that the form allowed doctors to take control, while only 41% believed consent forms expressed their own wishes for treatment.

Derogations, or departures, from the right to informed consent are necessary at times, but the question of when derogations may be permitted is a complicated one. When a patient is unconscious, medical providers must seek consent from a legally entitled representative. However, if there is an emergency situation where the patient’s life is in danger, medical providers may presume that consent is given. Issues of informed consent also arise from public health policies that require compulsory testing, compulsory vaccinations, or mandated quarantine during epidemics. Procedural safeguards are crucial to derogations from informed consent, to ensure that proper circumstances are met and to provide a means to challenge the departure from the law. Some groups are particularly vulnerable to violations of the right to informed consent. The UN Special Rapporteur on the right to health brought attention to children, elderly persons, women, ethnic minorities, indigenous peoples, persons with disabilities, persons living with HIV/AIDS, persons deprived of liberty, sex workers, and persons who use drugs.

The Inter-American Court points out the issues surrounding free and voluntary consent when it comes to women’s sexual and reproductive rights.Access to information on sexual and reproductive health is crucial for women to make free and informed decisions. According to the Inter-American system, access to information on sexual and reproductive health “involves a series of rights such as the right to freedom of expression, to personal integrity, to the protection of the family, to privacy, and to be free from violence and discrimination.”

There is also particular concern and confusion regarding the right to informed consent for persons with disabilities or mental health illness, two groups whose rights are frequently violated. Treatment decisions are often based on inappropriate factors such as ignorance or stigma surrounding disabilities, and indifference or expediency from staff. The Special Rapporteur on the right to health writes, “[These inappropriate considerations are] inherently incompatible with the right to health, [and] the prohibition of discrimination on the ground of disability … In these circumstances, it is especially important that the procedural safeguards protecting the right to informed consent are both watertight and strictly applied.” For more detailed information on disability and health, please see Chapter 9.

Persons unable to provide informed consent

Patients may be deemed legally incompetent to make decisions on their own behalf, including providing informed consent to treatment. Patients who are declared legally incompetent can include unconscious patients; minors; patients experiencing confusion or other altered mental states (this includes the elderly); those under the influence of sedatives or other drugs that affect alertness and cognition; and on occasion, persons with disabilities, depending upon their perceived impairment.

Many countries have a system in which a guardian or representative is authorized to make decisions on behalf of the legally incompetent individual. Depending on the jurisdiction and circumstances, health providers might also have the authority to commit a person involuntarily to a health care facility. Involuntary commitment is generally reserved for severe cases where the person is in immediate danger of harming him/herself or others.

There are frequent issues with guardianship and involuntary commitment because these processes involve denying an individual their autonomy to make decisions. It is crucial that the system be as formal and transparent as possible and to establish procedural safeguards to ensure that the dignity and rights of the individual are upheld. An example of a procedural safeguard for involuntary commitment is to allow courts or tribunals access to challenge the admission.For more information, please see Chapter 9 on Disability.

Prisoners

Prisoners who are ill often face violations of their rights as patients. Prisoners have the same rights as other patients, including the right to refuse treatment, the right to informed consent, the right to privacy and confidentiality, and the right to information. For example, they have the right to refuse treatment, including abortions and medical testing. Conducting these procedures without informed consent would be coerced or forced and in violation of the prisoner’s right to refuse treatment. Derogations from the right to refuse treatment in prison include the prevention and control of communicable diseases and the treatment of mental illness, but both are subject to specific conditions and should be implemented in line with international standards. The prison population includes especially vulnerable groups with special needs, including prisoners with mental health care needs, elderly prisoners, and prisoners with terminal illness. These vulnerable sub-populations may require special attention to ensure that their rights to health and life with dignity are realized.

Women

Women are particularly vulnerable to violations of their rights while seeking health care, especially for sexual and reproductive health care services. For example, Human Rights Watch documented abuse of pregnant women during health care visits in South Africa:

[Forms of abuse] include ridiculing or ignoring women’s needs when in pain, especially during labour, unnecessary delays in providing treatment, leaving women to deliver their babies without help, accusing women who appear not to be following nurses’ orders of wanting to harm their babies, verbal insults and degrading treatment, such as asking women to clean up their own blood, or intimidation and threats of harm. Physical abuse involves slapping, pinching, rough treatment and a deliberate refusal to give pain-relieving medication.

Other issues include independent and autonomous access to sexual and reproductive services, forced sterilization and forced contraception, and physical and sexual abuse by the care giver. Violence and assault against women in sexual and reproductive health care settings perpetuates stigma and discrimination against women that denies them human dignity.

The Special Rapporteur to health notes, “Stigma and discrimination against women from marginalized communities, including indigenous women, women with disabilities and women living with HIV/AIDS, have made women from these communities particularly vulnerable to such abuses.” The Special Rapporteur on water explains, “Stigma is, by its demeaning and degrading nature, antithetical to the very idea of human dignity. Stigma as a process of devaluation, of making some people “lesser” and others “greater”, is inconsistent with human dignity, which is premised on notions of the inherent equality and worthiness of the human person. It undermines human dignity, thereby laying the groundwork for violations of human rights.” Female patients from marginalized populations have the right to seek health care in a manner that is non-discriminatory and respects their dignity.

Access to essential medicines

Access to essential medicines is lacking in many developing countries. An estimated 1.3 to 2.1 billion people worldwide have no access to essential medicines. According to a 2011 study, about one third of the world population lacks regular access to essential medicines.Only 10% of pharmaceutical research and development spending is directed to health problems that account for 90% of the global disease burden. A small number of companies dominate global production, trade, and sale of medicines. Ten companies account for almost half of all sales. However, “Inequity in access to essential medicines is part of inequity in health care.” An expert consultation on access to medicines recommended in 2011 that “From the right to health perspective, access to medicines must be equitable. Additionally, more research and development is needed to promote the availability of new drugs for those diseases causing a heavy burden on developing countries.”

High pricing is another factor that hinders access to medicines. Companies that develop new medicines are often granted a patent, which permits that company to be the sole manufacturer of that medicine for a designated period of time. The expert consultation on access to medicines explains:

While intellectual property rights have the important function of providing incentives for innovation, they can, in some cases, obstruct access by pushing up the price of medicines. The right to health requires a company that holds a patent on a lifesaving medicine to make use of all the arrangements at its disposal to render the medicine accessible to all.

Access to essential medicines is considered an integral part of the right to health. However, 60 countries do not recognize the right to health in their national constitutions and more than 30 countries have not yet ratified the International Convention on Economic, Social, and Cultural Rights. General Comment 14 says that States must make public health and health care facilities available, including “essential drugs, as defined by the WHO Action Programme on Essential Drugs.”

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What is Elderly Care?

Biswas — Mon, 09 Nov 2020 08:55:28 +0000

Elder care, often referred to as senior care, is specialized care that is designed to meet the needs and requirements of senior citizens at various stages. As such, elder care is a rather broad term, as it encompasses everything from assisted living and nursing care to adult day care, home care, and even hospice care.

Although aging in itself is not a reason to consider elder care, it is usually the various diseases and physical limitations that accompany old age that prompt a discussion about elder care.

When is Elder Care Necessary?

Elder care is not always an absolute; in fact, some senior citizens never require any type of care to live independently in their later years. However, elder care often becomes an issue when a loved one begins experiencing difficulty with activities of daily living (ADLs), both safely and independently. ADLs may include cooking, cleaning, shopping, dressing, bathing, driving, taking meds, etc.

A general decline in health is often the impetus for the introduction of elder care, as it may indicate a waning ability to independently handle activities of daily living. For example, senility, which usually comes on at a gradual pace, may mean that a person who once remembered to take medication on time is now having difficulty doing so. Failing eyesight may mean your loved one is gradually losing the ability to move safely about the house, or advanced arthritis may mean he or she is having difficulty getting in and out of the bathtub without assistance.

The need for elder care may also happen quickly, as is the case if your loved one is recovering from a broken hip or recently had a stroke and is still suffering the cognitive and/or physical effects.

What is constant, however, is that elder care may be needed when a health condition –whether physical, cognitive, or even emotional – hinders the ability to safely complete activities of daily living.

Family members or a doctor are usually the first to recognize a need for elder care. The type of elder care that is right for your loved one, however, is largely dependent upon the type of health conditions he or she suffers from, the severity of the conditions, and the deficiencies experienced as a result.

It is up to both your loved one’s medical team and the family members closest to them to keep a close eye on any changes that may affect the ability to safely complete ADLs without assistance. There are a number of warning signs your loved one may display or exhibit that may prompt you to seek outside help:

Warning Signs to Watch Out For

Physical problems
- Gait, stability (walking problems)
- Sensory issues (a loss or decline in hearing, seeing, smelling)
- Chronic health conditions (diabetes, heart disease, arthritis)
- Temporary or permanent physical limitations that may inhibit the senior’s ability to perform ADLs

Cognitive problems
- Confusion
- Memory loss
- Attention problems
- Forgetting to take meds on time, at the right time, or at all
- Language problems
- Dementia

Emotional problems
- Depression
- Social withdrawal
- Loneliness
- Changes in personality (irritable, angry, moody, etc.)
- Loss of interest in activities

Physical Problems – Chronic health problems often come about as people age and are unable to perform many of the activities they once could. Their bodies may become more fragile, more rigid, and less resilient. Chronic illnesses may cause secondary impairments, or new illnesses to develop.

Disease-related physical impairments may be easy to spot or may be subtler. For example, senior citizens with glaucoma may not appear to be physically impaired, but their loss of vision may result in accidents and falls that may greatly impact their health or well-being.

Just because your loved one hasn’t reported a physical impairment doesn’t mean he or she doesn’t require care; therefore, a complete physical examination (including vision and hearing) on a regular basis is an important part of an overall health plan.

Cognitive Problems – Although cognitive problems, at least in their mildest form, can be expected as your loved one ages, some cognitive problems may impair a his or her ability to live safely and independently. Cognitive problems may cause memory problems, difficulty with language, difficulty making judgments, and difficulty regulating emotions, just to name a few. Mild dementia may not require elder care, but any type of dementia that is progressive and causes serious safety concerns must be addressed.

Emotional Problems – A decline in health, the loss of a spouse, the inability to do things once enjoyed, or the feelings of unimportance are all issues that may cause your loved one to experience emotional problems.

Emotional problems may manifest themselves in a number of ways. For example, your loved one may become socially withdrawn, moody or irritable, or may even have suicidal thoughts.

Many seniors deny the existence or severity of emotional problems, which makes the thoughtful observations of physicians and family members all the more important.

When to Begin the Discussion about Elder Care

Elder care should become a discussion as soon as changes are noticed, as postponing or delaying assistance could jeopardize your loved one’s well-being and safety.

Family members, along with your elderly loved one, should ask the following questions to get started:

What type of care is needed to ensure immediate/long-term safety?
What types of care are available?
What types of services can be used to provide care?
Can modifications/changes be made to the home or routine to remedy the situation, or is professional help required?
Can care be provided in the home, or is the move to a facility a better option?
What are the financial constraints of providing elder care?

The post What is Elderly Care? appeared first on Nursing Care BD.

What is Nursing Care?

Biswas — Mon, 09 Nov 2020 08:46:00 +0000

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 organisation 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 recognise that this goes beyond the priorities of our organisations 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 paralysing effect.

The first section of the original Francis Report (2010) is headed Patient Experience, and illustrates how the very way that “care” is thought about and conceptualised is fragmented and misses the point. The headings within the section are:

Continence and bladder and bowel care;
Safety;
Personal and oral hygiene;
Nutrition and hydration;
Pressure area care;
Cleanliness and infection control;
Privacy and dignity;
Record keeping;
Diagnosis and treatment;
Communication;
Discharge management.
All these are fundamental aspects of nursing practice, and need to be undertaken in a dignified, safe, caring manner; however, the way individual nurses do this is controlled by our attitudes, beliefs, values and actions. We need to reflect on our beliefs and values, our guiding principles and our underpinning philosophy as nurses. Without a clear articulation of these within practice and education, how can we assure the quality of our own and others’ practice?

Nursing care matters
Commenting on the culture at Mid Staffordshire, Francis (2010) identified that the primary issue raised by patients and families was the attitude of trust staff.

So what are attitudes, how do we develop them and how can we influence them? They emerge from our beliefs and values and are influenced by the setting in which we work and those around us – and they influence the way we behave.

Whether we label nursing care as basic, fundamental or essential is not important. What we must accept is that this care matters just as much as the technological and curative elements of healthcare. We need to move beyond a critique of how the relational and social aspects of care are overshadowed by the technical, and so move beyond patient-centred care to focus on an authentically compassionate, humanised approach to caring (Galvin and Todres, 2012).

Nurses need to place wellbeing and individual patients – with all their complexities – at the centre of what we do and, crucially, we need to be able to argue our case. We must defend what is right and ensure that all those working in healthcare understand that what we do, how we act as role models, teach and assure quality of care is as essential as any technological and curative element of healthcare. Mid Staffordshire has shown us that when care is neglected, people’s suffering is greatly increased.

Developing the capacity to care
While one cannot deny the great achievements of medical technology and increasing specialisation, care is more than cure – and, arguably, needs to be more than patient centred. Care needs to recognise us all as human beings whose experiences affect health and wellbeing directly.

I believe nurses need to develop the “head, hand and heart” approach, which integrates practical know-how with empathic understanding and technical knowledge (Galvin and Todres, 2012) to provide humane and sensitive care. We need to teach nurses and healthcare assistants about caring and what attitudes they need to achieve it safely and with dignity for everyone involved.

It is laudable and essential to demand that the NHS listens to patients and families (National Voices, 2012) but, as the initial Francis Report (2010) highlights, in an organisational culture that accepts bullying, lying, intimidation of staff and prioritising targets above patient health and wellbeing, we are bound to find resistance to change. So, how should we respond? Work on practice development in health and social care has shown that, unless the attitudes of staff towards those they care for and each other change, nothing else will (McSherry and Warr, 2008).

What influences our attitudes, beliefs and values? What do we see as the most important factor in what we do? If we prioritise treating each other as valued human beings with respect, dignity and care, then everything we do for and with those we look after will reflect that. All the issues outlined within the Francis Report (2010) will be dealt with to the best of our ability with a caring attitude, with the experience of those we care for put at the centre. Our thoughts and actions will be dominated at all times by a desire to do things in a way that would be acceptable for ourselves, our partners, our families and our friends, with empathy.

As we educate and develop the attitudes of student nurses and healthcare assistants, we need to consider how best we develop their ability to “walk a mile in another’s shoes”. We need to ensure that everyone – including managers and hospital board members – who works with vulnerable sick individuals has an attitude that enables them to empathise and listen to and learn from another’s experiences.

This shift in attitude means that dangerous staffing levels and standards of practice must be exposed. It is the nurse’s responsibility to maintain the best standards of care; this may mean that, if individual organisations ignore reports of dangerously low staffing levels and standards of care, then as a profession we need to consider how we share this information.

The label “whistleblower” is unhelpful when reporting dangerous and inappropriate care or staffing levels, as it smacks of the playing field or school yard. Perhaps we need to think in terms of safeguarding within the care environment, safeguarding safety and dignity by ensuring attitudes and actions are exemplary. We are the ones on the front line and know when things go wrong.

Reflection
On reflection, I believe we need to articulate our philosophy for care as nurses, which will inform our values, beliefs and actions, and we need to own it. We need to demand it of each other, our colleagues, our organisations and ourselves.

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