There’s a rather derogatory phrase that’s used more and more commonly in nursing of all branches these days. The phrase is..
“Too posh to wash”
What it refers to is the idea that basic tasks such as personal care are somehow beneath the professional dignity of modern nurses. Many of our more traditional colleagues seem to think that this is synonymous with degree education (another current hot topic in nursing) and that the more highly educated a nurse becomes the less likely they are to be prepared to get their hands dirty.
My own view is that the two concepts (education and task-based care) aren’t mutually exclusive at all. Let me give you an illustration.
When I was a Community Psychiatric Nurse (CPN) one of my clients had a delusion involving shadowy visions of a cowled figure. This client believed that the figure represented impending doom. As a result she had caused significant problems for people in her immediate circle, taking some very elaborate steps to warn them or otherwise to avert the danger she perceived.
This had been a problem for many years and several of my predecessors had tried in vain to help her either via medication or talking therapies. However none of them had dealt with the delusion ‘in passing’ before.
The particular conversation I have in mind was not conducted in the traditional way. There was no table between us – no notes were taken at the time (although they were later) and there was no formality. Instead there was a simple choice:
Toilet or bath?
In the end she chose the bath and so I got the delightful task of cleaning her toilet (not the nicest job I’ve ever had to do).
It’s interesting that people are much more likely to talk openly and honestly about a distressing issue when they’re enaged in something else. I think that this principle of engagement in a task in order to get to the root of a problem is one of the fundamentals I keep wittering on about in this blog. It’s not enough to sit and stare at the hapless client and expect them to ‘talk’. We need to get invoved in the real world – their lived experiences and what’s more real than a dirty toilet and a grimy bath?
We laughed and joked that day about how delightful the task ahead of us was. We drank coffee when we had a break before going back in to start on the walls and floor and we talked about the ghostly figure along the way. We talked about the fact that it only ever appeared during the night when the alcohol acting on her brain’s reticular activating cortex had kept her awake. We talked about how likely it was that her intoxication made her misinterpret the shadow accompanying the first rays of dawn. We considered the possiblity that her ‘mood’ lighting might be creating problems in itself and finally we got to grips with the fact that it was only ever seen out of the corner of her eye.
Moving on from there we talked about peripheral vision and the combination of all those factors until we agreed on a plan to re-establish a sleep pattern. We didn’t really deal with the alcohol issues that day but we did get a handle on the vision that had troubled her for so long. More importantly – we got her to consider alternative explanations and that’s a skill that eventually she learned to use in relation to all her delusional beliefs.
Along the way we covered issues such as selective abstraction, theory of mind, delusion formation, the nature of evidence and a philosophical concept known as ‘Ockham’s razor’. OK – I didn’t use those terms but the principles were there.
This is all pretty technical stuff and without the post registration training I’d never have known how to do it. But just as importantly I’d never have been able to do it if I’d been ‘too posh to wash’.
The value of task-based nursing should never be underestimated. But neither should the value of nurse education and informed practice. It’s not enough to be prepared to get our hands dirty (although that’s important). We must also understand what to do while our hands are dirty and that takes education, training and a willingness to understand.
It's time nurses and others working in health and social care realised that ignorance most definitely is not a virtue.