20. Rhetoric or reality?
Nursing in Criminal Justice Services Forum
(MFD) That this meeting of RCN Congress discusses the question ""non-judgmental care: rhetoric or reality?""
Debate report
Donna Goddard from the Criminal Justice Services Forum asked Congress whether the idea of non-judgemental care is rhetoric or reality.
Presenting this matter for discussion, she said that nursing staff make professional judgements on a daily basis and that professional standards are in place to stop nurses imposing their own values on patient care. In criminal justice settings, staff work in an environment designed to punish, when their role is to promote health and wellbeing.
“How non-judgemental are you,” and “how do we manager our emotional labour,” she asked.
Andrew Kirke, Lancashire West Branch, provided a vivid illustration of the issues under discussion.
He described the death in A&E of a four year old who had been doused in petrol by his father. After a failed resuscitation attempt, he then had to treat the father in a nearby cubicle.
“Non-judgemental? Absolutely not,” Andrew said. “Did I allow that to affect the care I delivered? Absolutely not.”
Zeba Arif, of the Forensic Nursing Forum, acknowledged that providing non-judgemental care was difficult. “But it’s always so rewarding when someone realises you are looking at him and seeing the human being and nothing beyond that.”
Swansea Branch member Kiera Jones said people made judgements about both her health and her sexuality because she is bald. Her husband is 25 years older and looks “like someone out of ZZ Top”, the famously hirsute rock band, she said.
Many people made assumptions about their relationship. “I don’t have a problem with them making judgements. But I do have a problem when it affects health care,” she said.
Background
The recent announcement by Prime Minister David Cameron and Health Secretary Andrew Lansley of the establishment of a nursing quality forum has generated widespread debate in regard to compassion, dignity and respect in nursing care.
Nursing behaviours and attitudes towards patients span all services and settings in both the NHS and the independent sector. In its Code, the Nursing and Midwifery Council (NMC) sets out its care expectations and provides clear guidance in relation to discrimination, integrity, diversity and equality of care.
However, in 1972 an RCN research project examined nursing notes to explore the concept of the ‘unpopular patient’, contesting the contemporary view that nurses treat patients in a non-judgmental fashion. The study’s findings challenge today’s nurses to consider the nursing reality in terms of one’s own judgemental care, attitudes and behaviours. This debate invites delegates to consider the broad spectrum of nursing care and their area of practice in (for example) learning disability services, drug misuse, prisoners, older people, the homeless, self-harm and mental health, dementia care or sexual health.
The topic of non-judgmental care is being addressed in all four UK countries. The recent Patient Rights Act (Scotland) 2011 sets out the principles that underpin the need for non-judgmental high quality care, and Scotland’s chief nursing officer is currently focusing on professionalism in the delivery of care.
The experiences of nurses during the Troubles in Northern Ireland are particularly relevant to this debate, as the RCN History of Nursing Society’s recent research project demonstrates. Nurses provided care to both the victims and the perpetrators of violence, irrespective of their community background and often side by side in the same ward. In 2009, the 204 (North Irish) Field Hospital Volunteers won the Outstanding Achievement Award at RCN Northern Ireland’s Nurse of the Year ceremony. The citation commended their non-judgmental approach to care provision in respect of the armed forces, Taliban and local people.
In Wales there has been a focus on providing high quality care through developments such as the Welsh Government’s Empowering Ward Sisters programme (2008). Meanwhile, recent work led by the 1000 Lives Plus programme has included a Transforming Care at the Bedside (2011) initiative to enable registered nurses to spend more time with patients and clients to improve essential care delivery.
The RCN has established its Principles of Nursing Practice (Royal College of Nursing, 2012), supported by the NMC and the Department of Health (England), for use in all care settings. In addition, the RCN is working closely with the International Council of Nurses (ICN) to develop an agreed set of principles for care. The ICN’s ethical code for nurses (ICN, 2006) exists to illustrate the principles accepted across the international nursing community.
References and further reading
International Council of Nurses (2006) Code of ethics for nurses, Geneva: ICN. Available at: http://www.icn.ch/about-icn/code-of-ethics-for-nurses/
(accessed 8/3/12).
Nursing and Midwifery Council (2008) The code: standards of conduct, performance and ethics for nurses and midwives, London: NMC. Available at: http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf
(accessed 8/3/12).
Royal College of Nursing (2012) Principles of nursing practice, London: RCN. Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0011/349499/003863.pdf
(accessed 8/3/12).
