Dancing Nurses Vanquish Evil

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No self-respecting blog about nursing and culture (and possibly they number more than one) could ignore what happened on Friday night. The Olympics opening ceremony boggled eye and brain. It was an ambitious attempt to re-imagine what British things were worth celebrating without recourse to forelock-tugging, corporate branding or celebrity glitter. Some crass mouthbores slated it as socialist. As if there was some sinister bias revealed in the motto that ringed the stadium before the appearance of Tim Berners-Lee - THIS IS FOR EVERYBODY.

At the centre of the pageant was the unexpected partnering of children’s literature and the NHS as represented by 800 puff-sleeved dancing nurses and dozens of ecstatically bed-bouncing children. The dark spirits of Lord Voldemort, the Childcatcher and other fictional villains were driven back by co-operative goodness and some airborne Mary Poppinses. And they weren’t hired actors pretending to be nurses; they were actual nurses and other healthcare workers who had volunteered their own time to rehearse weekend after rainy weekend. To learn exits and entrances and jitterbug kicks for the joy or satisfaction of just taking part. Watching it was to zigzag between thinking, this is madness and this is brilliant.

The reasoning behind the juxtaposition was that J.M Barrie, author of Peter Pan, gave all the rights for the work to Great Ormond Street Children’s Hospital, and it was fitting too that his words were read out by JK Rowling who has passed a great deal of her wealth on to projects such as a new research clinic for neurodegenerative diseases at Edinburgh’s Royal Infirmary. Literature is good for your health.

Removing healthcare from the day-to-day and setting it in this fairytale wonderland, addressed to the whole world, allowed us to see it for a moment in a new light. I mostly consider myself immune to the emotion of national spectacles, if not downright repulsed. The Jubilee, for example, had me running for the literal hills.  Yet I found myself vulnerable to the sheer optimism and egalitarianism expressed by ceremony writer Frank Cottrell Boyce, one of the creative team behind the ceremony.

But maybe I’m coming down with a case of age-related tenderness.  I’d be interested to hear what others thought about those dancing nurses. Chuffed or queasy?

nurse performers return home post-ceremony 

An Art?

Gabriel Orozco 'My Hands are My Heart' 1991

Last week I attended a study day for intensive care nurses and AHPS (yet another acronym to digest – for those who don’t know, it stands for Allied Health Professionals - physiotherapists and speech therapists, for instance)

At lunchtime I got talking to some experienced ICU nurses. We’d been discussing a presentation we’d been given about agitation in ICU patients, and how careful monitoring of sedation levels was needed to find the right balance between wakefulness and unconciousness. As I understand it, sedation that is too deep can hold back a patient’s recovery, while too little can make it difficult for a patient to tolerate the invasive breathing tube, not to mention the various lines, drains and cannulae.‘Of course,’ one woman remarked,  ‘A lot depends on the nurse.’

When I asked what she meant she said that older or more experienced nurses were more likely to have developed strategies to calm a patient. Really good nurses had the ability, she said, to create a tranquil atmosphere, just through the quality of their presence. ‘Are you saying it’s an art?’ I asked. ‘Yes,’ she said, clear as a bell, ‘It’s an art.’

It is so much easier to talk about clinical techniques, about monitoring and measurements and checklists than it is to talk this way, about art and intangibles, how nursing can work on a level that I can only, godless heathen that I am, describe as spiritual.

In my reading I come across accounts by individuals who have suffered life threatening illnesses and who write about the importance of certain subtle interactions to their recovery. Richard Selzer, an American surgeon and writer receiving treatment for Legionnaire's Disease in an ICU wrote of the skilled nursing care he received, calling it ‘transformative’. He describes being carried back to bed by a male nurse after a bath as the moment when his ‘molecules rearranged themselves’ ‘It is the true moment of cure,’ he writes.

David Rier, an Israeli sociologist, was admitted to an intensive care unit with a virulent form of pneumonia. Unusually for an ICU patient, he was alert or semi-alert much of the time and the notes and observations he made provide an insight into patient experience in the ICU that is rare in its thoroughness and which changed his own thinking about medicine. In his fascinating account, he credits a large part of his recovery to the atmosphere of the ward.

“The staff’s cheerfulness, and the personal attention they lavished on me, gave me a strong sense of security. As mentioned earlier, this conviction that everything was under control and would turn out all right remained with me through most of even the most critical phase of my illness. But given my weakness, not even the staff’s smiles and attention could have sustained this security had they given me the full, discouraging story they were giving to my wife,” Rier is of the opinion that at his most ill, bad news would have killed him.

“These points are crucial” he writes, “because I am convinced that this cocoon of optimism helped save my life.”  David A. Rier The Missing Voice of the Critically Ill (in Sociology of Health and Illness vol 22, 2000)

The non-clinical aspects of care – human interaction, empathy, encouragement, nurture – are often referred to as ‘soft skills’. It’s not a good phrase. Within a society so devoted to the hard and fast and innovative, it is belittling and dismissive. Yet what evidence there is points to these intangible exchanges as essential to recovery and healing.