Can nursing care ever be 'basic'?

This is a collaborative blog post by:
Andrew Sargent - Tutor and PhD student at King's College London
&
Charlie Johnston- Student Nurse at University of Lincoln

We have both made a few observations on this question below.

Andrew Sargent:
There is a lot of talk about student nurses doing a year of work as a Healthcare Support Worker prior to commencing their studies, to learn 'basic nursing care'. 
This of course comes from the Secretary of State for Health, Jeremy Hunt in response to one of the recommendations of the Francis Report.
Naturally the idea has been met with much resistance and has invoked a great deal of debate.
This issue aside, there is a more pressing question that needs to be asked here; what is 'basic' nursing care?
This question has been asked before the recent events surrounding the Mid Staffs Inquiry. I am aware of the term being used for some years now. I have in the past (very politely) reprimanded students and colleagues that have referred to some aspects of nursing practice as basic. 
Take hygiene as an example, if you are assisting a bed-bound patient with hygiene needs there are a whole range of knowledge and skills needed:

• Assessing the patient's self-care deficit (How much or little are they able to do for themselves)
• Involvement, willingness and consent of the patient.
• Consideration of the limitations involved (dressings, wounds, prostheses, range of limb-movement, equipment attached to the patient etc)
• Identification of equipment required (are there special considerations re soaps or cleansing products)
• Evaluation of skin integrity (wounds, sores, infections, allergies)
• Knowledge of skin physiology (identifying areas of potential damage).
• Awareness of issues around surgical wounds and dressings.
• Dignity, privacy and individuality.
• Communication before, during and after the procedure.

I could go on... but I think that you get the idea. There is more to this than just flicking a wet cloth around. Furthermore, the procedure of being with the patient is an opportunity to assess other care needs, evaluate current care implementation and to discuss any issues that the patient needs to talk about.

In short, there is a whole range of skills, knowledge and behaviours that are required by the nurse; there is nothing 'basic' about nursing. Nursing requires an in depth knowledge of many subjects and also requires interpersonal skills to ensure that the care is Person-centred.

So, why do we refer to any aspect of nursing care as 'basic', why are some advanced skills demeaned with this terminology? 

It's tempting to say that there is an underlying agenda to divest some of this important work to unqualified (and cheaper) HCSW's as a cost-cutting exercise. After all, Nurses are expensive!

I wouldn't like to say that this is necessarily the case, but by altering the language around certain nursing skills (by relegating it to that which would seem to be achieved equally well by non-professionals) does nothing to promote the importance of having a higher number of experienced, qualified nurses in clinical practice.
(AS)

Charlie Johnston:

We must be very careful when applying terminology to the care we provide. On the whole, I believe the term “basic” isn’t being used to deliberately devalue the care we provide in any way, but more to effect of describing the very minimum that we must get right. However, I feel the word “basic” invokes the idea of a set of instructions or tasks that anyone can achieve with relative ease, and of course, most people probably could do so. 

For example, the above points by Andrew demonstrate the thought process that one must apply when performing personal care. If we were to take the first 7 steps and work through this list then the task would have indeed been completed. But when we think about our role as nurses there is and should be much more to it that that. That interaction with the person may be their only and therefore most important interaction of the day.

Essentially it’s fundamental to that person’s experience and I feel, to describe such an important aspect of someone's care as “basic” almost infers that they are low on a list of priorities which I feel only serves to devalue that person to us, which of course, when aiming to provide person centred care, should never be the case.

This is where the implementation of the last 2 steps become very important and prove that such care is not “basic”. It is these 2 steps which are the essence of nursing and create a good patient experience.

It is the untangible, the identification of the nuances of each and every person and the tailoring of such care to each. This, to me, is not “basic” but important. It’s what gives us the ability to touch lives and for me at least..and I know I speak on behalf of many wonderful nurses...it’s fundamental.

  

Just a few more ramblings on Jeremy Hunt and his idea of introducing a minimum period of work as a HCA before applying to study Nursing. Overall, I think I sit on the fence. Despite my initial reaction of mutterings that are probably best to avoid publishing, I now sit on th fence. I can see why Mr Hunt believes his idea is a good one and indeed it would open a few eyes of those who lack experience. Agreed. But on the otherhand, I fear that it would become little more than a hoop to jump through and possibly, I worry anyway, that it could create the idea that performing such work and fulfilling the role is little more than a stepping stone onto bigger and better things?

(CJ)

We would value any thoughts and comments that you have on this subject. Please feel free to use the comment box below.

Andrew Sargent & Charlie Johnston May 2013