An excellent guest blog on the importance of sensitive and trusting nursing from US-based Melanie Bowen.

Chronic illness can be very difficult to endure for patients and their families. During times of greatest need, sufferers of life-threatening diseases require all the support they can get from healthcare providers, family and friends.
Since patients will spend most of their time accompanied by a nurse in a medical facility or in-home nurse while at home, the strength of the bond that forms between the two could be the key factor in determining recovery rate and potential.
Even if recovery is impossible, good support can bring calmness, acceptance, and closure to the afflicted.

Why is emotional support so crucial to the recovery of patients?

As human beings, we are emotional beings. Our fondness for one another is based on a combination of similarity, frequency of interaction, sentimental behaviour, and emotional and intimate connections. The more ‘proof’ that a person receives from another individual to show that they care, the more attached he or she becomes to the supporter.
Humans need to have confirmation and assurance of their relationships with others to feel secure. Without actions, words mean nothing.
Nurses who show genuine desire to help and befriend patients are the ones that do their jobs the best.

How can a strong relationship between nurse and patient affect recovery?

From liver failure and brain tumours to pleural mesothelioma and malignant melanoma, a close bond between caregiver and patient can speed up recovery time and improve the chances of survival regardless of how grim the circumstances.
First, a positive and honest relationship between a nurse and patient gives the patient happiness. Knowing that somebody trustworthy is always there to look out for them can be a very comforting thought that reduces massive amounts of stress and anxiety.
Fear of death cannot be avoided, but strong physical and emotional support can brush aside many of those constant worry that add to stress and anquish.
Additionally, many chronic patients do not have any family or friends to visit them during times when they need the most love. Caring nurses can replace those missing loved ones to provide the same important emotional support that helps the afflicted fight on despite the overwhelming odds.
Second, caring nurses have intimate knowledge of their patients. This is a huge advantage when providing medical assistance that lessens the strain and pain.
Take the example of 26-year-old breast cancer patient Theresa, whose nurse, Jessica, was her caregiver and also became her best friend. Having been by Theresa’s side for many years, Jessica knew Theresa’s medical history. She gave Theresa candy before the drugs that always initiated her gag reflex, to use a longer needle on her, and to check her bowels if a physician doesn’t request an enzyme test.
By contrast, patients who have to transition frequently between nurses don’t have the beneficial personal connection. New nurses aren’t familiar with how the patient has things done, and they don’t have the personal bond to make them care for the patient like a true friend.
Lack of knowledge about and lack genuine concern for a patient are two things that could hinder recovery progress and contribute to worsening health.
Finally, a significant personal bond between nurse and patient give nurses more reason to give their all in providing for the sick. After spending so much time together, the patient is no longer just a stranger but a good friend. As a true friend, a nurse will have personal reasons along with a career obligation to provide the best care possible.

Congratulations to the University of Nottingham, Dying Matters and the National End of Life Care Programme for producing the excellent Planning for your future care publication.

It is written in simple, positive prose and covers all aspects of Advance Care Planning including what is the most difficult aspect, ‘Opening the conversation’.  The tone for the leaflet is set in this telling phrase: ‘Not everyone will choose to engage in such a conversation and that is fine. However, talking and planning ahead means that your wishes are more likely to be known by others.’

I was particularly pleased that the leaflet covered wishes and preferences, and that these included some of the end of life experience defined in the My Last Song ‘death plan.’  Planning for your future care suggests where you want to be, who you want to be with, types of treatment, ‘how you like to do things,’ with examples such as sleeping with the light on or having a shower instead of a bath.

If you, or an ailing loved one,  want to have a ‘good death’ instead of a lonely, frightening end of life, then read Planning for your future care and act on its advice. To make the end of life experience as good as it can be,  fill in your own personal death plan, a template for which is available in the My Last Song Lifebox.

The wishes and preferences are more holistic, covering the music you want to hear; the smells you want surrounding you; the food and drink you wish to taste; the sensations you want your body to feel, such as caressing, massaging, stroking; what you want to see, such as a lovely view or your favourite photographs; how you want to look – clothes, make up, hair style; and ensuring the practical issues are resolved so you have no concerns.

By involving loved ones, doctors and if appropriate ministers of religion or spiritual advisers, having a death plan will go a considerable way to ensuring, if possible, the death is as comfortable and comforting as possible.

Geraldine Beddel, editor of Gransnet, wrote a very thoughtful piece last week which argued that our society has unwittingly colluded in the mistreatment of old people by our widespread casual ageism.

Her thesis is that until we respect our elders, the pernicious cruelty towards old people will continue.

While I agree with her arguments I would like to make two observations.

The first is that these attitudes are far more prevalent in the indigenous, longer established population and much less in the families from Africa and Asia where the wisdom of age is much more valued and respected.

People from these continents are used to seeing their elders work hard, without the protection of a welfare state and pension schemes. In these cultures, a person is brought up and protected by the extended family, and as they get older they then look after those who’ve looked after them. 

There’s self interest and community interest at heart here, and it works well. Where this family/community protection is replaced by the state or other institutions, the appreciation of the human relationship is rapidly diluted. 

When transplanted into this country, such respect for older people remains for one or two generations. I know several African families very well, and respect for elders is a value that is instilled into the children. Any ageist remark or attitude is sometimes literally slapped down.

The second point is that we should value old people not just because they brought us up, but because they have so much to teach us. Again this is where communities from less developed countries can illuminate our failings.

Their idea of education was less through formal schooling and more from the passing down of wisdom, ideas, values and experience from generation to generation. The collective learning of old people was critical to the success or failure of a family, village or tribe.

In our more developed culture, old people may not play such an educational role, but their memories, life stories, achievements, attitudes make up micro social and family histories.

We should understand their worth and do all we can to keep them, because once lost they are lost forever.

This is why the Lifebox is such a useful service.  It’s an online secure area designed to enable personal histories to be uploaded and stored, then to be accessed by chosen younger family members.

It’s probable that many older people who will want a Lifebox will need the help of younger family members to populate it, and in doing so, the bonding between young and old will increase the mutual intergenerational respect.

This in turn will reduce our tendency, pointed out by Geraldine Bedell, to dismiss the value of our older family members.

So Southern Cross, unsurprisingly, threw in the towel. The country’s largest care home operator couldn’t make ends meet.

Some of the landlords of their care homes will take over the running of them. As for the others, well there are few organisations lining up to take these over and so the Government has made the statement that nobody currently in these homes will be made homeless. Any further details conspicuous by their absence.

The Government must be aware of the ever growing problems being stored up in the provision of care for the increasing older population. It’s a double whammy…more people are joining the age group of 80 plus, and more within this group are living longer.

There is no sign of the reversal of the social trend of families, particularly those of the vast majority ‘traditional’ English families, losing their cohesion. An interesting aside here is that most of the immigrant communities bring with them strong family values, not all of them virtuous as can be seen by the increase in honour killings within the more tightly knit groups, whilst the strength of family unit of the indigenous population weakens.

So who will provide the care that an increasingly large proportion of this increasingly large group of elderly people will require?

There may be a huge market here, but I don’t think there’s a business in the market. Residential care requires a lot of costs: spacious properties and their maintenance; specialist equipment and medical supplies and a large labour force.

The income? Local authorities won’t have the money unless given increased ring fenced grants from central government. And the governing party (or coalition) will be loathe to increase taxation to pay these costs until this becomes the only socially acceptable answer.

My guess is that within ten years we’ll see a two tier system for the care of our elderly. A private sector catering for those (or their families) with the funds to pay for a high quality level of residential care and a state funded sector of homes run by a decentralised arms length agency for the rest.

It was with this sort of problem in mind that we put some advice on funding care options onto My Last Song.  It will be prudent to read it and to act on it before it’s too late.

The passage of time, like death, is impossible to deny but is often overlooked.

Advice I never forgot: I was 17 and had finally plucked up courage to ask a lovely student nurse to come to a local dance with me.  To my surprise and delight, she accepted. That Saturday evening I spent a lot of time on my appearance…I was after all a mod, and everything had to be right. I came downstairs looking pretty sharp, and dad gave an appreciative look.

“Got a date?” was his rhetorical question. I told him I was going out with a student nurse. He made sure mum was out of earshot and said to me: “Son, there are only three certainties in life.”  He paused for effect and came close to lower his voice…”tax, death and nurses.”

I won’t tell you whether he was right or not. But I will tell you that since that evening I have had an everlasting admiration  for nurses, not as girlfriends, though I’ve had one or two since then, but for the quality of care they give to their patients.

I have particular respect for the nurses who look after the patients at a care home in Streatham where a friend of mine has been looked after since her stroke five years ago.  But their level of dedication, their strength, kindness and patience is replicated in care homes, hospitals and hospices up and down the country, and includes those who visit their patients in their homes.

It must be particularly difficult to care for and nurse patients who are suffering the late stages of dementia, when there is so little communication between patient and nurse. The patient is usually just a shell of a person, and that shell can be very difficult given the sometimes aggressive behaviour, or if medicated, someone with little or no response to any stimulus.

Late stage dementia patients have no short term memory, but can often recall things that happened  many years ago.

The section in the Vault within My Last Song for favourite fives – where subscribers can list their favourite five of anything (examples could be cars, operas, authors, Motown songs…) could be something that is particularly useful for prompting the memories of later stage dementia sufferers.

A close family member could give the printed out favourite five pages to the care home so that the nursing staff, and other medical professionals, have a prompt that could stimulate some meaningful communication, experiences that mean so very much to the patient…the rare but special moments when they come alive again.

And if this makes the experience of the nurse that much more rewarding and fulfilling, so much the better.