A lost cause, if ever there was a cause

To bring about closer collaboration between the medical and social sectors, the Hospital Authority (HA) of Hong Kong, which manages all public hospitals in Hong Kong, has announced, after a three-year pilot project, that it is ready to implement an integrative care model for helping at-risk elderly people who are discharged from hospitals meet their immediate transitional needs. Under the guidance of the HA, non-governmental organizations (NGOs) will have a social worker from the collaborating NGO stationed in the hospital to assess patient needs.

When I learnt about the initiative, I realized it was already a lost cause for community nurses to be champions of community support and care. I worked as a community nurse for a year in the mid-1980s. Back then, there was not much emphasis on community services and care, but now it is entirely different, with governments and health authorities all over the world realizing the importance of keeping patients in the community.

To me, nurses can also be brokers of community services as long as they have knowledge of the service agencies and support services available in the community. It intrigues me as to why we need another professional—a social worker—to come and be stationed in a hospital. Many community nursing centers are an integral part of hospital services. Community nurses go to the wards to assess patients prior to discharge when they receive a referral from the attending doctor. Now, a social worker will be stationed in the hospital and visit the unit to conduct patient assessments. It is a duplication of health resources.

Given the nursing shortage, nurses are ever so cautious when it comes to taking up new roles and responsibilities. Yet, when we focus only on what we cannot do because we believe we are overloaded, we do not see the possibility of what we can do. We need to show stakeholders that we are willing to take on new responsibilities for the purpose of providing holistic care to our patients.

At one time, nurses could have been the champions of community care. We could have done so much more for our patients. But we stayed in our comfort zone of defined practices. We would only see patients who had a referral—to dress a wound, give an injection or teach self-administration of injections, supervise walking exercises or change a catheter. Anything that was to be done had to come with a physician’s order.

Why would health education or patient counseling need a doctor’s referral? Charging for services is, of course, an issue. That is understandable. However, what is stopping nurses from going the extra mile to do the liaison work, to find out the needs of patients and families, and refer patients to the community support services they need, instead of asking them to seek a referral at their next doctor visit?

We need to wake up to the call of our nursing vocation and make ourselves visible and accessible.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Reflections on student learning

This semester I am teaching a course, “Nursing older people.” One of the assignments I have for my students is to write a reflective journal about any issue pertaining to elderly people and elder care, to be submitted at the end of the semester.

I thought it was an easy enough assignment but, to my surprise, my students do not think so. They tell me it is a burden to them. Quite a number of them say that they don’t know what to write about or how to write it. Again, this is a surprise, because these are third-year students, and reflective journals should not be new to them.

In response, I have modified the assignment with regard to it being a requirement, but have not removed it as part of the course assessment. To me, it is important when studying gerontology to cultivate sensitivity toward elder care issues. The best way to do that is not to write a paper or take a test, but to reflect, over time, on issues pertaining to elder care. Gradual sensitization to elder care issues through the writing of journals will help students develop awareness and insight about care of older people and, I hope, enable them to develop their own perspectives about the study of aging.

But this is not an age that encourages reflection. We humans like to fill our world with sounds. We are so uncomfortable with quiet moments that we try all means to drown our senses.
We need to be entertained every single moment. As soon as we arrive home or check into a hotel room, we turn on the radio or TV. We are defined by the latest electronic gadgets and games, by the PSP, iPhone, iPad and so on. We must have music constantly, whether it comes from an iPod or any other means. We can’t be bored.

We also can’t bear not being connected, even for brief moments. We have the Blackberry, 3G phones, WiFi, etc. Everywhere we go, we want immediate access to the Internet.

Because we are so busy entertaining ourselves, engaging in dialogue with people we know or don’t know, being reached and reaching out to othersand accessing information for all realms of our lives, the time that remains for reflection and recollection is very limited. Although Schön’s seminal article on reflective practice was published in 1987, more than two decades ago, fostering reflective practice nowadays runs counter to modern techno currents—not a very promising battle.

Personally, I need a lot of time to myself. I like people, but I also like solitude. Getting together is good to foster relationships, but getting close to myself and knowing how I feel and think is crucial to living a life that is meaningful to me.

I hope my students become, through repeated learning opportunities, better reflective practitioners.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

When I was young, I was naive.

I believed it was enough to teach nurses to meet basic requirements in providing care. I believed it was unreasonable for us to ask our students to love everyone. (That is still not a realistic expectation.) I used to believe in standards, quality audits and core competencies. (I still believe in some of these things, but in a different frame of reference.) To my mind, as long as everybody did his or her job properly, that would do.

I was wrong. It is not enough to teach our students to meet standards, have their competencies verified by tests or check, through peer- or self-appraisals, whether they have mastered the required skills.

There are so many different systems of accreditation being developed nowadays. Under modern accreditation systems, piles of documents explain protocols, guidelines and procedures about how things are done in a particular context or setting. They have a limited connection with the quality of care. Having documents in place doesn’t mean that the things said in the documents are or will be observed. It only means that specific instructions exist about how something should be done (and is believed to be done), and when and why it is done in certain ways.

As I grow older and, I hope, slightly wiser, I have come to realize that standards and competencies are not enough on their own. As I lecture, work with students on projects and supervise them in field practice, I am gradually coming to see how flawed my thinking was.

The most important thing about nursing is caring—caring about, not just for. It is only when we care about something that we strive to do well, to do better. When we care enough, we show it in our work and how we carry ourselves in practice. It is only when we care about those we serve and our profession that we strive to become better nurses and people.

But the global trend embraces the science of nursing more than the art of it. Something is amiss, but are we aware of what we are missing?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.