The Commodity of Care – Politics and Poor Nursing Care

41AGvzzHThL

http://books.google.co.uk/books?id=8785BAAAQBAJ&pg

 

The following link provides updates to this book:

http://qualityofnursingcare.webs.com/

UPDATES ADDED BY CAROL DIMON

 

The aim of the  The Commodity of Care  was to analyse why poor nursing care is still occurring within care homes and hospitals in the UK, the USA, and Australia, despite numerous recommendations over at least 30 years. It became evident through the course of research that provision of care depended on the dominant political ethos, sometimes termed free market ideology or neoliberalism – terms describing an economic theory which claims the market should be the sole determinant of people’s lifestyle choices, and that the market should be free from government interference, since it is self-regulating. …

This book will consider how the dominant political ethos impacts on care in nursing homes and hospitals in the UK, the USA, and Australia, and similarly influences organisations involved in nursing regulation and education, and attitudes towards care of the elderly. This book will draw upon correspondence with various organisations, and will include the “voices” of those involved in front line care. …

“I work on a 36 bed med teaching floor. We typically have a ratio of 9 patients per RN, with only one or two aides on the floor. Hourly rounding sounds great on paper, but putting it to practice is a joke …. The 90 year old dementia patients are constantly checked on because they usually have no concept of time and will call the moment you leave the room. Nurse’s discretion dictates that those that need more care receive it. With a mountain of charting and admissions to do and only one aide to help out, realistically, that’s the way it’s got to be. If administration wants me to recite my script every hour to these patients and sign my sheet, they need to mandate a better nurse/patient ratio”. …

Horton (2007) claims neoliberals view of the world as a “vast supermarket”. Yet, as Horton describes, the disadvantaged cannot “shop” at this supermarket. This reflects the preoccupation of neoliberalism with consumerism and the acquisition of goods, and neglects to address society’s caring role. Horton describes the resulting control held by the ruling class, who have “approval and consent of members of society”, as “hegemony”. As a consequence, those on welfare benefits may be regarded with less compassion, as they are viewed as not contributing towards the wealth of society. The Government may say they are “empowering” individuals to make choices (when buying private health insurance), but their true aim may be abdication of responsibility, and focus on capitalist goals. …

In the UK, nurses will be required to have a degree from 2013. “The move either escalates nursing to a the lofty intellectual heights it deserves, or condemns patients to wallow in their own filth while the nurses that used to look after them ponder the abstract philosophical principles of post-modern Bauhaus management techniques” (Fleming 2009). A nursing degree student may point out that their course contains ample clinical placement, where practical skills are learned. Yet, what is wrong with having a vocational career? – open to those who would make good, caring nurses? Governments imbued in neoliberalist philosophy will inevitably consider such an option in light of budget considerations, and it is a matter of contention as to whether patient care would suffer. Is the move toward degree level nursing fuelled by the desire of some nurses to elevate the status of their job? …

“0n my ward they have just replaced four qualified them with 4 HCA’s. Now we have an issue with covering sickness, annual leave and maternity with bank or agency qualified staff, who, even if we get them, are not familiar with the ward, so do not know where things are, and, in some cases, cannot speak good English, or perform tasks that you would expect a qualified nurse to be able to do”. … (copied verbatim from article)

Student nurses, in particular, may find challenging poor care very difficult; issues of student nurse conformity to the prevalent norms of their placement has been highlighted in research (Levett-Jones et al 2009), in which students “described how and why they adopted or adapted to the teams and institution’s values and norms, rather than challenging them, believing that this would improve their likelihood of acceptance and inclusion by the nursing staff.” Yet, nursing lecturers are not required to visit student nurses who are on placement. Universities do, however, have protocols for student nurses to raise concerns, as do NHS and private hospitals, but these protocols involve complaints being kept “in-house”, with clauses forbidding “whistleblowers” to go to the press. …

Amber Paley (2012) reports on abuse in UK, USA, and Australian care facilities: “In the US, the Department for Health and Human Services found that 91 percent of nursing homes fail to meet federal requirements for care. Seventeen percent of nursing homes between 2005 and 2007 were reported for exposing residents to abuse or neglect that did or could have resulted in serious injury. In 2004 alone, more than 500,000 cases of elder abuse were reported in the U.S. She reports on one particularly harrowing case: “One particular story that hit home with many Americans in 2011 involved …. a 78 year-old resident of the Quadrangle Senior Living Community in Haverford, Pennsylvania. Sensing abuse, McCallister’s daughter and son-in-law placed a hidden camera in her bedroom. What they found was horrifying. A dementia patient, the video captured McCallister being hit, taunted, poked in the eyes, and having her ears pulled. …

In the UK, Wighton (2011) analysed NHS hospital complaints pertaining to attitudes of staff: “George Argent was a cheerful man with an easy manner — the former sailor enjoyed nothing more than his daily jaunts into the local village and meeting friends for a Friday pub lunch. But the 81-year-old was scared and humiliated in the weeks leading up to his death. Shouted at and belittled by nurses, the widowed grandfather was scolded for soiling his sheets while suffering from superbug clostridium difficile, and laughed at when he asked for some clean hospital pyjamas”. In cases of attitude, individuals may excuse the behaviour or provide an alternative perspective (ibid.). …

“I am not confident that the training I have received at university is sufficient. Basic skills training is lacking. More time needs to be spent in placement areas and less time essay writing about subjects which have little relevance to a patient’s care”. …

The university basis of nurse education is profoundly affected by business models (Popenici, Kerr 2013) that offer the nursing student an academic route leading to a PhD; the student having done little or no actual nursing. The student then finds themselves in competition with numerous others. A weapon of the State is a relentless promotion of positive thinking: “our country must be among the best”; “our country must be a leader”; the individual is encouraged to “persevere and work hard”; “alter their attitude”; “focus their mind”. Thus, the problem of unemployment is not of society’s making, but one of individual failing. The individual is a pawn in a Lutheran perspective – work hard for personal redemption, and for the good of the state; these aims being synonymous. The student is likewise encouraged to see higher education as a ladder to success; the hard working will progress through the rungs of degrees, to be eventually rewarded with a high status job; a perverse fallacy, as the ever-increasing horde of PhD jobseekers testifies. …

Some of the following conclusions and recommendations, additional to those suggested in the text, are based on an opposition to changes brought about by political dogma which is leading to an apartheid system of health care, with “winners” who can afford private health insurance being segregated from “losers” who cannot. These changes are being introduced on a tide of neoliberal rhetoric which crudely attempts to divide people through targeting the self-interest motive of the young, who “shouldn’t have to shoulder the burden of the elderly”; and of the poor working class, who “shouldn’t have to support “scivers”. …