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Universities might be selecting the wrong people to become nurses

1 March 2016

Robin Ion

Universities might be selecting the wrong types of people to become nurses, a radical new article in the journal Nurse Education Today suggests.

This idea is just one of many the article highlights as it draws attention to the compassion deficit debate and urges those involved in nurse education – as well as both professional and student nurses – to think about the role they can play in preventing care failures such as those detailed at the Mid-Staffordshire NHS Foundation Trust from ever happening again.

Written by academics from five leading nurse education institutions – the Universities of Abertay, Edinburgh, Stirling, and Edinburgh Napier, as well as Leeds Teaching Hospitals Trust – this is the first time so many nurse educators have come together in an attempt to bring coherence to the ongoing debate and to move it forward.

Dr Rosie Stenhouse – lead author of the article – explains:

“There is no question that, in most cases, the care provided by nurses is very good. Compassion is at the heart of what we do. But we can’t ignore the fact that poor care does exist. As nurse educators, we are duty bound to acknowledge this and to work out how we can equip nurses with the skills and knowledge to prevent anything similar to the Mid Staffs scandal from ever happening again.

“People often blame the system, but in this article we go deeper than that and discuss some fairly radical views, including the idea that there might be a fundamental lack of compassion in some of the individuals who become nurses. Nursing is seen in many ways as being untouchable – that everyone who does it is an angel – but the evidence suggests that this isn’t always the case.

“We also discuss the possibility that it might not be the health care system that is the problem, but the way we are teaching nurses. If we are unable to produce nurses who are capable of providing compassionate care, then perhaps we need to rethink how we are delivering our nurse education.”

She continues:

“These issues are extremely complex and it is important to recognise that there is not going to be one single solution. The ones we highlight in this article are many and varied and must be seen in terms of the complex interplay that exists between individual and organisational factors.

“With this in mind, our aim in highlighting all these points is to get practitioners and students to reflect upon the impact that their actions as individuals can have on improving patients’ overall experience of care. These actions, no matter how small, will begin to improve the system right now, while wider organisational changes are discussed, decided upon and implemented over the coming years.”

In addition to the role of institutions, the article discusses a number of other thought-provoking ideas, including a paper suggesting that the ‘compassion deficit’ of the prominent Nazi Adolf Eichmann may explain how large numbers of people can become complicit in morally reprehensible activities.

Written by Robin Ion from Abertay University, who is co-author of the wider Nurse Education Today article, the paper draws upon the work of the political theorist Hannah Arendt, who uses Eichmann’s trial as a paradigmatic case for how large numbers of people can become complicit in morally reprehensible activities.

In her landmark book – ‘Eichmann in Jerusalem: A Report on the Banality of Evil’ – Arendt suggests that what leads people to collectively carry out such heinous acts is not just an inherent malevolence or wickedness but, quite simply, the ‘inability to think’.

It is this ‘inability to think’ – think through, critically reflect upon and question what they were doing – which Ion believes is pertinent to the events that took place at the Mid-Staffordshire NHS Foundation Trust.

Robin explains:

“Over recent years, reports such as that of Robert Francis QC have dented the reputation of nursing, by questioning the traditional view of the nurse as a compassionate and caring professional.

“There has been incredulity at – and, quite rightly, widespread condemnation of – the ‘morally reprehensible’ activities of healthcare professionals, but in order to properly understand how such systemic neglect could have occurred, we need to look deeper than to simply take the traditional view and say it was down to the actions of a few bad individuals.

“When Arendt used Eichmann’s trial as a paradigmatic case for how large numbers of people can become complicit in morally reprehensible activities, she said that he possessed ‘the inability to think’.

“By this she didn’t mean that he was stupid. And she certainly wasn’t seeking to trivialise the gravity of his acts. Rather, she was proposing that the downfall of those who possess this ‘inability to think’ comes from their failure to think through, reflect upon and question what they are doing.”

However, he points out that although Eichmann was highly intelligent, it was by focusing solely on finding the most efficient way to carry out his orders – without thinking through, or thinking about, the effects of what he was doing on his fellow human beings – that he became one of the chief orchestrators of the Holocaust.

He believes something similar occurred at Mid Staff:

“At Mid Staffs, there was a single-minded focus on reaching targets and meeting goals cost-efficiently, which meant that those in their care were left out of the equation and only considered as an after-thought, or – more often than not – forgotten about completely.

“Although Arendt’s theory remains a challenging and controversial one, it is only by attempting to properly understand how something so morally reprehensible could have happened that health care education providers – who are responsible for training the nurses of the future – will be able to prevent such widespread and systemic ‘moral catastrophes’ from happening again.

“Of course, nursing staff need to be efficient in order to ensure the effective running of our hospitals, but this cannot be at the expense of caring for their patients.

“As education providers, we need to be aware of what can happen when this type of ‘habituated thoughtlessness’ – as Arendt put it – prevails, and balance the need to help students develop the problem solving skills they need to carry out procedures effectively, with the equally important ability to ‘stop and think’, ask questions of, and challenge the nature of these systems themselves.”

The article – Exploring the compassion deficit debate – is published in Nurse Education Today and can be viewed online.


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