The influence of really listening: learning what excellence in care looks like

摘要

Can the pursuit of the reliable delivery of truly person-centred care be compared with the never-ending quest for the Holy Grail – or is it more akin to the search for the Higgs boson particles, which took decades to identify? There have been significant improvements in the delivery of care over the past three decades, but one doesn’t have to look far to find evidence of poor care and practice – at times for no apparent reason. So, how realistic is the reliable delivery of truly person-centred (safe and effective) care? As one of the early nursing undergraduates in Scotland, I was desensitised to poor practice; ‘It’s all right in theory, but doesn’t work in practice’, was a commonly held view. The academic perspectives on nursing practice were questioned widely in terms of how connected they were to real life, with little in the way of practical application. Since then, the profession has matured significantly, in particular with the keystone move to higher education and an all-graduate profession. Evidence is fundamental to the delivery of excellence in care and we would not be where we are without our university schools. However, do we have enough evidence? How relevant is it to our day-to-day challenges? How effectively do we apply it in our everyday work? When I was a board nurse director, I was at times seduced by the argument that we needed to manage patient expectation, and that poor care was inevitable in our busy, demanding systems. After all, these things happen, don’t they? While I was incredibly proud of much of the care that was delivered by the nurses within my health board area, there continued to be aspects of practice that troubled me. I recall someone who died by suicide while in our care, a young person with a learning disability in one of our acute hospitals being badly let down by the nurses, and the distress of a daughter who had placed her mother in our care, with confidence that turned out to be misplaced. I remember these patients by name and their cases contributed to my reflecting anew on what people were telling me, and to a shift in my thinking. So although the turning point for me was gradual, with an increasing consciousness of the impact that poor care had on people and their loved ones, the awakening to really listening and reflecting on people’s experiences has had a profound effect on my practice. It has also been a ‘eureka moment’ for me and given me confidence that, with the right conditions, we can truly reach a state where we reliably deliver person-centred care across the whole of the NHS in Scotland.