Sunday, 18 March 2018

Cartesian Conversations: Nurse Education; Seeking Healthcare; and the Importance of Hand Washing

A few months ago I was contacted by one of my old magistrate colleagues. She was someone I hadn’t seen since I retired from the bench a few years ago. She asked if I would come and speak to the Bolton Branch of the National Women’s Register. It wasn’t a group I was familiar with, but as the focus for the talk was around nurse education and whether we were preparing nurses for the future I readily said yes. Which is why last Wednesday, I found myself at a rather grand house, sitting in a circle of 15 women talking about nurses, nursing, education, research and practice. The average age of the women was about 65+, three of them had been nurses, and one a doctor. It was an interesting conversation and the two hours I was there flew past.

I was not only able to talk about nurse education, but also how the provision of health care had changed and the continuous opportunities there are to improve health care services. Some of the group were already familiar with the changes that digital technology can bring, particularly around remote care, health monitoring apps, and developments such as key-hole surgery, and new scanning and diagnostic interventions. Of course we also touched upon what I described as the ‘Daily Mail’ view of the NHS. Perhaps predictably the discussion was around the demand for A+E services, trying to get an appointment at the GP, and how long it can sometimes take to get an operation.

I reflected on the discussion afterwards. Despite the ladies listening and asking some tough questions, the context for these was perhaps not unsurprisingly, the very traditional view of the NHS. As a group they were hospital centric, and found it difficult to think outside of that box. I guess there might be many more who think like the ladies in this group. For example, last week I went to a GP practice to support a friend, and it was like Bedlam. There were people everywhere, it was hot, and tempers were frayed. The promised 15.00 appointment turned out to be 16.20. It may therefore be understandable that some folk will simply give their GP a miss and pitch up at A+E.

Such choices were something I had discussed earlier on in the day last Wednesday. I chair the Wrightington, Wigan and Leigh NHS Trust Quality and Safety (Q&S) Committee. The unceasing demand fed through the A+E department, has a ‘knock-on’ impact to other parts of the hospital. Getting people to theatre in the optimum time possible was a particularly difficult issue this month. I guess from my reading, our Trust is not the only one experiencing these problems. Another (seemingly impossible to resolve) problem is the prescribing of oxygen. This also came up in the Q&S committee. Whilst those who need oxygen in an emergency situation wouldn’t be denied this, prevailing guidelines indicate that oxygen should always be prescribed.

Oxygen is not always seen as a prescribing substance, and it’s always given when needed. Asking a doctor to write up a prescription after the event is often seen as an unnecessary bureaucratic hindrance. So prescriptions don’t always get written. Whilst we agreed on an action plan to try and improve this situation, I was reminded of poor old Ignaz Semmelweis. He gave his name to something we now know as the Semmelweis Reflex. This describes the notion that people reflexively fear taking on something new. In the 1840s, Semmelweis worked as a doctor. He came up with a radical idea, and it was an idea that if adopted, might have saved thousands of lives.

One of the things he noticed was the way in which doctors walked away from treating those dying, or those already dead and continued to work in areas such the maternity ward. He noticed that the maternity wards also had very high mortality rates. Indeed, he felt women would be better off having their babies delivered at home. His insightful idea was that doctors should wash their hands between treating sick patients and delivering babies. The collective medical profession of the time said NO to this idea. Semmelweis didn’t prosper, he developed a mental illness and eventually died in a mental health hospital. Of course, as we now know, all health care professions recognised what he was suggesting was actually right. We now all routinely wash our hands as we enter wards, or attend each new patient. 

And last week, it was Thursday that gave rise to a situation that made me smile the most. Young Lucy, studying psychology at Leeds University, disappeared upstairs to write what I understood was an assignment on the philosopher Descartes.  Of course it was Descartes that famously said: je pense, donc je suis; I think I therefore I am. But it is his work on Cartesian dualism that caught my attention in this situation. Lucy eventually re-appeared in the lounge. I asked how she had got on with her Decartes assignment, only to be told that she had been busy sorting out her fake suntan, and hadn’t written a word of her assignment. The Cartesian dualism, mind and the body, personified. Perfect!