Returning to the fundamentals of care 

9 October 2019 

“There is a hard nurse and there is a soft nurse…”

“The hard nurse approaches me with an opening such as, ‘What’s this pain in your chest?’ and instantly I know she is not concerned with me as a person but with the condition that has brought me into the hospital (the biological or the scientific). But the soft nurse asks, ‘How you are this afternoon? How is your wife and your family?’ and I know this nurse is concerned with me as person and my situation (the practical) not just the medical condition.”

These are the words of a terminally ill patient with lung cancer, explaining to UK Professor and Registered Nurse Wilf McSherry how he got ‘treatment’ in the hospital and ‘care’ in the hospice.

“This illustration tells us two fundamental things about patients, the public we serve. Firstly, they want care - caring - not just treatment; and, importantly, they can distinguish the type of practitioner who is likely to provide this,” says Professor McSherry, who has dedicated much of his career to exploring the relationship between nurses and their patients. Professor McSherry’s urge to explore the humanity of care was triggered early in his career, when he was working as a Registered Nurse on a busy, 25-30-bed medical ward. 

“I’d just finished my four-year nursing degree program and thought I was prepared for anything, that I could conquer anything.”

Then he met Peter.

“Peter was 72 years old and admitted to the hospital with an acute episode of chest pain. A diagnosis of angina was made since ECGs showed no evidence of recent infarct,” Professor McSherry recalled.

“I met Peter the following afternoon as I was starting my shift and he was preparing for discharge. He had asked me to pass him his clothes and I did so, drew the curtain and began to walk out of the room.”

“I don’t know what drew me back to look behind that curtain, but I did and found Peter collapsed on the bed.”

He had developed sudden severe central chest pain and collapsed with a cardiac arrest. Resuscitation was being initiated when Peter’s wife arrived on the ward.

“She pleaded to see her husband multiple times, at one point lunging angrily at the registrar saying, ‘Who the bloody hell are you to tell me I can’t see my husband?"

Peter had only been in hospital overnight and had not seen his wife because she had taken herself off to see their daughter after an argument.

“His wife was ushered back to the dayroom. She didn’t see Peter, and he went on to have a full cardiac arrest and he sadly died.”

“After Peter’s death his wife asked if the Catholic priest had been and it then came to light that Peter was a practising Roman Catholic who found meaning and purpose in his beliefs.

He says inspection of the nursing notes showed that nothing in relation to religion had been entered.

“In my four-year degree, we’d never covered anything on people’s personal religious or spiritual beliefs. The word ‘spiritual’ wasn’t even mentioned.”

“What this scenario highlighted for me was the medical model of care.”

“There was a focus on systems, on biological systems, on making sure the cardiovascular system was functioning correctly, and we missed a key element of Peter. And that was his beliefs, his values and how they were important to him.”

It marked a turning point in the young nurse’s career. “I met Peter and his wife decades ago and I still see that lady leaving that ward.”

The experience drove the Registered Nurse back to university to undertake post-graduate studies on nurses’ perceptions of spirituality.

“For me, this isn’t just an academic endeavour—this is about practice, this is about people, this is about making sure that experience is fundamental in terms of seeing the person.” Spirituality, he says, goes beyond the formal notions of ritual or religious practice.

“Spirituality is universal, deeply personal and individual. It is at the core and essence of who we are, that spark which permeates the entire fabric of the person and demands that we are all worthy of dignity and respect. It applies to everybody, whether you have religious belief or not.”

“Spirituality is about people’s beliefs, hopes and aspirations—what gives people hope or purpose. And for far too long, spirituality has been missing from our health, nursing and midwifery language. A lot of our culture, our identity and our personal narrative is rooted in spirituality—how can we miss that?”

“What type of care are we providing if we omit a key element of what it is to be a person?” For this reason, Professor McSherry is lobbying the UK’s Nursing and Midwifery Council to reinstate the word ‘spirituality’, which was removed from the country’s Code of Professional Practice in the 1980s.

“We seem to have been knocked off balance. We’ve been asked or forced by politicians, by government, by a whole range of other professions, to adopt models of care that perhaps divorce some of these humanistic, these altruistic aspects of what it is to be a nurse, a midwife, any health or social care professional.”

“We all need to have connection, we all need to have relationships and we all need to find meaning. Some might find this in religion, others might find it walking in nature, being outdoors, running or beekeeping.”

“The word ‘relationship’, the word ‘connection’ these are all parts of spirituality.” Professor McSherry’s work is inspiring nurses and midwives the world over to champion the reintroduction of spirituality and the humanity of care in health care settings. 

“I’m asking you to join the social movement to add this word ‘spiritual’ into our everyday practice,” he said to attendees at this year’s Australian Nursing and Midwifery Federation (SA Branch) Annual Professional Conference. 

“Spirituality and dignity remind us to focus our attention on the individual – the person, not the medical condition or treatment. When we remove that, we start focusing on money, finances, policy, bureaucracy, guidelines, strategies. All of these are important, but let’s not lose sight of what they’re designed for, which is people.”

“People see your attitude straight away as soon as you walk into a caring context.”

“It isn’t the high-tech which is important, it isn’t always the medical, it isn’t always the academic and the educational. It’s those little things at times of vulnerability in suffering and pain, even in joy.”

“It is a smile, a warm word of welcome, a ‘how are you?’, a ‘please’ and ‘thank you’. It is our demeanour, our professionalism, our openness, courtesy, respect, and ultimately our approach to care.”

Wilfred ‘Wilf’ McSherry is currently Professor of Nursing at Staffordshire University, working jointly at the University Hospitals of North Midlands NHS Trust. He is also a part-time professor at VID University College in Norway.

Read the full October 2019 edition of In Practice