Recently, at a standardisation meeting for an undergraduate nursing module in the final year of study, I expressed disappointment to my team of colleagues that in a piece of critical reflection we were discussing, a student had cited a YouTube video as supportive evidence for the importance of introducing herself to her patient. A colleague on the marking team defended the student, informing me that the YouTube video had been a key component of a recent campaign to encourage everyone working in the health service to introduce themselves to individual members of the public in their care. I confessed that I had not heard of this campaign but that I remained dissatisfied with the quality of the student's supportive evidence. After some discussion, the module team agreed that the student should be marked down for insufficient attention to evidence.
I am wondering what we have come to when a highly educated workforce, such as the one currently populating our health service, is thought to require a promotion campaign to guide their behaviour in the direction of what is a basic tenet of human communication and common courtesy. Furthermore, the notion of such a campaign is highly suggestive of a reductionist approach to what has been shown to be a complex and sensitive skill central to the nurse-patient relationship.
It seems that it still cannot be overstated that caring is not simple (Benner and Wrubel, 1989). Just saying ‘Hello’ and introducing oneself by name are not enough. A shop assistant at a supermarket checkout knows this much. But then far less is expected of a shop assistant in the aftermath of ‘hello’ than a modern nurse. Eckroth-Bucher (2010) argued that, for the first encounter between a nurse and patient to successfully ‘gateway’ for a positive outcome, self-awareness must first be in place. This forestalls tactlessness or presenting behaviour that might be perceived as intimidating, inappropriate or culturally insensitive. Self-awareness is closely allied to the mastery of emotional labour in which the nurse works her emotions to find the correct level of response that complements the patient's emotional state (Theodosius, 2008). Empathy (McKinnon, 2018) and a willingness to view the patient as a partner in care (McKinnon, 2011) are also important parts of achieving and sustaining a productive person-centred relationship.
These theoretical concepts form a small representative part of the substantial body of knowledge that is the nursing epistemology. They take meaningful shape in the social skills of nursing life; calm reassurance in the face of a patient with dementia who is terrified, empathic listening with a family angry from their sense of loss, warmth and earned trust with a child who misses their mother and father, understanding and compassion for the young man receiving end-of-life care. Where these skills falter, it is likely to be because the nurses in question are exhausted by a lack of rest (Zammuner and Galli, 2005) and the relentless demands of their working environment (Borneo et al, 2017), not because they need to be reminded of the importance of introducing themselves. Consequently such campaigns are as patronising as they are inappropriate.
Notwithstanding the implications for everyday practice, nursing academics should discourage superficial exploration of evidence pertaining to reflection on practice. The unconsidered use of media sources to support arguments in a written assignment is one of the favourite tools of students hoping to ‘wing’ a piece work. The sidelining of active meaningful reflection as part of professional praxis in order to give more time to biomedical science subjects is the route back to habitualisation of practice. The notion that caring need not be deconstructed and is something that can be done by any good person is politically dangerous; it is a social falsehood that should be opposed.