Tag Archives: care

Duty of care: A slug in a bottle

Donoghue vs StevensonIf there’s one thing that unites almost everyone concerned with health and social care services it’s the fear of being sued. Otherwise rational and courageous workers have been reduced to quivering wrecks at the mere suggestion of litigation or the slightest suggestion that they might have failed in or ‘neglected’ their duty of care.

Duty of care is such a preoccupation for workers that it crops up daily in conversation and in practice whenever we encounter ‘thorny’ issues relating to ‘health and safety’, ‘rights and responsibilities’, ‘freedom of choice’, ‘confidentiality’ and a host of other topics. What all of these conversations have in common is ‘duty of care’.

However not everyone who hears the term understands what it means or indeed where it comes from. This is a shame because as we all know knowledge is power and one way to know about something is to know a bit about its history and development.

Lord Atkin delivered a judgement in the House of Lords on August 26th 1932, thus ending a legal battle that had gone on for four years. The judgement became what is known in UK law as a ‘binding precedent’ because (with the exception of the new Supreme Court) no other UK court has the authority to overrule the principle that comes from it. This is the principle that most Duty of Care decisions are based upon.

What is this principle that was so important it still affects us today? We’ll get to that. First let me tell you the basic facts of the story.

May Donoghue was a shop worker in Paisley, near Glasgow who, one Saturday afternoon went with a friend to buy an ice cream float at Frankie Minghella’s café. As it turned out Mrs. Donoghue didn’t pay, her friend did – and this is significant.

Having finished most of her ice-cream float she discovered the partly decomposed carcass of a slug in the bottom of the bottle that had contained her drink. She was later treated for gastro-entiritis (presumably as a direct result of consuming some of the corpse).

Mrs. Donoghue’s next move was to sue the owner of the café. However the café owner, Mr. Minghella argued that his only duty of care was to the person who bought his goods and since Mrs. Donoghue had not paid herself there was no legal case to answer.

Not to be deterred Mrs. Donoghue turned her attention to Mr. David Stevenson whose company had manufactured and bottled the soft drink in question. The argument was that Mr. Stevenson had a duty of care to the people who used his products in the end – however far removed they may be from his own bottling and production plant.

Lord Atkin’s ruling was that Stevenson was responsible and stated in the ‘Obiter Dicta’ (legal jargon for ‘last words’ that explain the judgement) that we all have a legal responsibility not to injure our neighbour.

“You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour.”

The definition of ‘neighbour’ he used was this:

“persons so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected when I am directing my mind to the acts or omissions which are called in question.”

In other words we all have a legal duty, ‘a Duty of Care’ to consider the effects of our actions upon other people who may be affected. In health and social care this basic principle includes following the various rules and legal obligations that surround our work.

In practice it means that:

We all have a duty of care to the ultimate consumer

That’s the principle of this case: Donoghue v Stevenson 1932. However far removed we might be from the face to face ‘frontline’ of clinical practice we all have a duty of care to ensure that our practice is safe and reasonable.

 

Course design 9: Schema (build on what they know)

According to Wikipedia a schema can be described as…

  • An organized pattern of thought or behavior.
  • A structured cluster of pre-conceived ideas.
  • A mental structure that represents some aspect of the world.
  • A specific knowledge structure or cognitive representation of the self.
  • A mental framework centering on a specific theme that helps us to organize social information.
  • Structures that organize our knowledge and assumptions about something and are used for interpreting and processing information.

http://en.wikipedia.org/wiki/Schema_(psychology)

This is one of the reasons for the importance of themes and the sequential structure of topics that are introduced in a logical order throughout the training day. It helps participants to maintain a cohesive schema. But there’s more to it than that.

All of your training ‘victims’ will have their own schemata (worldviews) already. They bring them into training with them and good training acknowledges that.

If the materials you present appear to conflict with their pre-established worldview then you will have great difficulty in maintaining their interest, their engagement and your own credibility. So it’s important to start the ‘journey’ they will take through the training with what they already understand. To put it another way…

Meet them where they are

In the previous instalment I used the example of a deliberate self harm course for a reason. It’s because it provides us with an excellent illustration of how to use participants’ pre-existing schemata to gain engagement and then lead them on to new discoveries and more sophisticated understanding. Let me explain….

Many people believe that deliberate self harm is all about us. They think (because for years care professionals have told them) that deliberate self harm is all about attention seeking and manipulation. The reality is that this is not true but to begin with this blunt statement would meet signficant resistance that the trainer may never really overcome.

So before we can lead people to this realisation we need to do two things…

First we need to give the participants a reason to change their minds – they must make their own decision. As Rudyard Kipling once wrote

“A man convinced against his will

Is of the same opinion still”

Secondly we need to ‘soften the blow’ by incorporating as much of their pre-existing knowledge into the new belief system as we possibly can.

In deliberate self harm training I usually do this by exploring coping in general and by asking the group about their own coping skills. Once we have developed a long enough list of coping skills we highlight the ones that induce chemical changes in the central nervous system. At this point we have not directly mentioned self harm, just general coping skills.

In this way we tap into the participants’ existing schema about coping and then added a small piece of information (that doesn’t contradict their original view) which is that they are manipulating brain chemistry to feel better.

Only once they have clearly understood the chemical aspect of coping skills such as exercise, alcohol and substance use, arguing, making love, relaxing/meditating, comfort-eating etc do we make the point that physical trauma also stimulates endorphins in the central nervous system in exactly the same way.

We have begun with what they already understand about their own coping, added a piece of information that is non-threatening and then introduced the same information to demonstrate that deliberate self harm is just another version of what we all do.

This is working with the participants’ schemata. It also remains consistent with the general themes of the training…

  • Deliberate self harm is a coping strategy.
  • We’re all the same.
  • Care workers are not the focus of people’s problems – it’s not about us.

By taking the time to work with peoples’ schemata we can introduce some quite sophisticated concepts over the course of a day without difficulty. It isn’t uncommon for participants to report a completely changed point of view by the end of the day without having to overcome any significant resistance during the training. This lack of resistance is a sign that attention has been given to step by step development of their existing schemata rather than trying to go straight into what may be contentious, unfamiliar or otherwise uncomfortable for them.

 

Privileged glimpses 24: The clinician’s illusion

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

The clinician’s illusion sounds as though it would only apply to clinical, therapeutic situations but that’s not the case at all. This is one of the most widespread examples of faulty thinking and we are all susceptible to it. Essentially it’s one of several logical errors that are based upon the false idea that ‘my experience is all there is’.

There are very good reasons why human beings are so vulnerable to the clinician’s illusion. Many would argue that it’s inevitable because we base our judgements upon our experience of the world. In evolutionary terms that’s one of the main reasons why our species has survived at all. This is probably as ‘hard-wired’ into consciousness as any human trait could ever be. We all learn from experience.

Unfortunately that experience can be misleading as we shall see.

To make sense of the clinician’s illusion I want to tell you a little about my own experience as a mental health nurse on acute psychiatric wards. Then, having made the point we’ll widen the scope a little to show how the clinician’s illusion is both applicable to all of us. We’ll also show how our vulnerability to it is used by cynical persuaders from private citizens to politicians who manipulate our understanding to gain agreement or endorsement of their views.

When I worked on the wards my colleagues and used a familiar expression – a cliche if you will. It went like this:

“We don’t have much money but we do see life.”

It was, as much as anything a relatively light-hearted way to acknowledge amongst ourselves that sometimes we witnessed and were involved in situations that were distressing, unpleasant and occasionally harmful. What we saw on a fairly routine basis had the potential to cause very real psychological trauma in its own right and I have known many mental health nurses who have been unable to bear its weight. The use of clichés such as this is more than just a way to acknowledge that ‘shit happens’ – it’s also a way to demonstrate mutual awareness and support. Like the ‘gallows humour’ so often heard on ward nights out (and so often criticised by the uninitiated) it’s part of an arsenal of psychological defence mechanisms that nurses at the front line employ to keep themselves sane.

But there’s a major problem with this. It’s not true. Well – the not having much money part might be but not the rest. Acute nurses do not see life – at least they don’t see very much of life. They see the worst of life but not the best.

By definition patients in acute psychiatric wards are distressed and they are not coping well. If they were then they’d be somewhere else getting on with their lives. Acute nurses meet people at their most unwell – and only at their most unwell. And many of them return repeatedly to the wards as their mental health breaks down.

Our experience then, as ward based nurses was that everyone with a diagnosis of serious and enduring mental disorder comes back to us sooner or later. We see them come back every working day and that experience of working with relapsing patients is what we used to form our opinions. That’s why, when I was an acute nurse I didn’t believe in recovery from mental disorders such as schizophrenia. I had no experience of it. Everybody I met at work had relapsed (or I expected that they would one day based upon my past experience of other people).

But not everyone comes back.

According to the Royal College of Psychiatrists own figures only about a third of people diagnosed with schizophrenia experience lifelong deterioration and another third (give or take) get beyond their problems altogether. We didn’t see those people on the wards because they never needed us again. We only saw the people who did relapse.

Not everybody relapses

The clinician’s illusion is the illusion that comes from limited experience. Clinicians see ill people and so they come to believe that everybody is ill – or at least likely to become so.

The clinician’s illusion is what happens when we place too much weight upon our own limited experience and ignore the wider experience of others. It’s the fatal flaw that underlies the statement so beloved of many that..

“I speak as I find”

It’s laudable, of course to learn from our own experience but not to the exclusion of everything else. If we really want to make sense of the world we need to be prepared to look beyond our own experience and take account of the experiences of others.

Oscar Wilde once remarked that only a fool learns from his experience. The wise man learns from the experience of other people. Perhaps Wilde would have called the Clinician’s illusion the ‘fool’s illusion’ for precisely that reason.

But it’s not enough just to say ‘learn from everyone’. It’s necessary to have some means of judging the reported experiences of others too – otherwise we’re open to all sorts of abuses and misrepresentations. My own view is that ‘evidence is the thing’.

Don’t worry too much about anecdote – that can be misleading. Follow the evidence. Otherwise we end up making just as many mistakes.

For example there is a narrative in UK about people with disabilities and those who need to rely upon state benefits to survive. The narrative is that disabled people are workshy scroungers and that honest hard-working people should not be asked to support them. This narrative has proven to be very persuasive and many people (largely those who do not work with disabled people) believe it. Let’s look at why..

Ever since the ConDem government came into power back in 2010 UK citizens have repeatedly been told that benefits claimants are predominantly abusing the system. Government ministers have repeatedly made that claim and the real evidence about claimants and their circumstances has repeatedly been suppressed.

Right wing media articles repeatedly publish stories about people ‘swinging the lead’ and even ‘fly on the wall’ television shows present benefits cheats to the nation on a very regular basis. For the majority of people (who don’t regularly come into contact with severely disabled citizens) this constant procession of fraudsters becomes the only experience they have of disabled benefits claimants. And cynical politicians know this all too well.

So the clinician’s illusion (my experience is all there is) means that the population is easily swayed by arguments about benefits fraudsters because they believe that it’s a real problem when in fact official figures (the evidence from a range of experiences) show that only a tiny proportion of claimants are ‘swinging the lead’. But that’s not what our political leaders want us to believe. So that’s not what we are shown.

Unless we become alert to the notion of the clinician’s illusion in our own lives we will remain susceptible to persuasion by any Tom, Dick or Harry who wants to manipulate our opinions for their own cynical ends.

For example, if your only experience of someone you meet is what they tell you about themselves it pays to look a little deeper before you jump in and support their endeavours. You might just be being played.

I’ll end with another cliche.

“Self praise is no recommendation”

Privileged glimpses 23: “It’s just behavioural”

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

The young woman sat hunched in her chair, not making eye contact with any of the half dozen or so people seated around the little room. It was hot, stiflingly so with so many bodies in such a small space. All eyes seemed to be upon her as a moon-faced man, dressed in an immaculate suit, began to speak.

“How do you feel this afternoon?”

The young woman didn’t answer as she picked imaginary lint from her blouse.

“Have you been taking the tablets?”

The man in the suit, a consultant psychiatrist, seemed to be addressing his patient but his attention had already shifted elsewhere. He had given up waiting for a response even before he’d finished speaking to her. Now, along with everyone else in the room (except the patient herself) he was looking at me, her primary nurse.

“Everything’s been given as prescribed.” I said. “No problem.”

The psychiatrist nodded and half-smiled his approval. My patient, all but forgotten now, stared at the floor in silence.

A few minutes more discussion between the various members of the team followed about the relative merits of antidepressants ensued. Then, again looking directly at me, the psychiatrist asked:

“Do you think you’re getting any better?”

I waited for her to answer, shifting my own gazer toward her in the hope that others would try to include her also. Perhaps this would help her to feel noticed again. Then the psychiatrist spoke again:

“Is she improving, Stuart?”

There was no response from the patient so I explained that she had indeed made progress, she was sleeping and eating normally and had begun interacting with other people on the ward too.

“No evidence of that here, is there?” The psychiatrist quipped, eliciting tiny, almost imperceptible smiles from one or two of the others in the little room.

I explained (again) that these team meetings were intimidating for her and that her presentation on the ward was far more relaxed. I explained again about the work we’d done on the ward and how she was able to talk about her problems with us and her depression was lifting every day. I also pointed out that she specifically asked that I explain this precisely because she lacks confidence in this setting.

“It’s just that she feels much more ‘on show’ during the ward round”.

The young woman raised her head a little and grunted her agreement, albeit rather timidly.

“So you can speak.” Said the psychiatrist. “You just choose not to speak to me.”

Once again the woman’s gaze dropped to the floor in front of her. She said nothing more in the ward round although she did begin sobbing quietly to herself upon learning that she would be discharged home that day.

After she left the room (it’s strange how readily people accept the decisions of psychiatrists and just go) I made the point that although she was improving she wasn’t well enough for discharge yet. I believed, the whole nursing team believed, that another week or so would make all the difference. I pointed out that her lack of confidence in the meeting was evidence that her former high self-esteem had not yet returned.

“That’s only behavioural.” Said the psychiatrist as he completed the discharge forms.

I’m always interested to know just what people mean when they describe a person’s actions as ‘behavioural’. Actually I’d be interested to know of any action that isn’t ‘behavioural’.

In the health and social care context (including psychiatry) what ‘behavioural’ usually means is that we feel powerless to change the behaviour or that we are at a loss to understand it. Actually the two meanings often go hand in hand as a little understanding does tend to point the way to the solution anyway.

It’s not difficult to understand why this young woman was so quiet (elective mutism we call it in the trade). It’s not difficult to see the solution either – a smaller group meeting, perhaps with only one or two people present and some attempt to engage with her as a person rather than as a set of symptoms would probably have worked wonders. It certainly helped in my one to one sessions with her on the ward.

However, such understanding would require a little thought, flexibility and even compassion. It’s much easier to write the situation off as ‘behavioural’, all the time pretending that the word actually means something clinical and isn’t just an excuse for our own lack of imagination.

A fundamental premise of this series and of care provision in general must be that everything we do is behavioural but that nothing is ‘just’ behavioural. If we want to be effective we need to stop hiding our own inadequacies behind this meaningless term and take the time to understand the individual instead.

Everything happens for a reason and effective work with people whose behaviours can be challenging must begin with that ‘cause and effect’ principle clearly understood.

Privileged glimpses 22: The whole team approach

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

The whole team approach

I have mentioned several times throughout this series of posts the importance of consistency throughout the whole team. There are several reasons for this:

  • Clear boundaries;
  • No ‘pedestals’ & staff safety;
  • Effective, consistent care;
  • If you can’t stop the person behaving poorly you can at least stop them doing it to you;
  • Corporate identity – “you’re all the same”.

As we consider these reasons we will also be outlining the argument that staff who are too ‘permissive’ when faced with genuinely unacceptable behaviour are actually counter-productive. They do their clients no favours.

It is my belief, however hard or unpopular it may be, that such workers should have no place in health and social care. The outcome of such poor boundaries can be tragic and yet it is all too common for workers to forego their responsibilities in practice.

Health and social care workers need to develop the strength of character necessary to maintain consistent boundaries. They need both peer and management support to do so. We ask a great deal from staff who are faced with challenging behaviour and we owe it to them to offer sufficient support as well.

It has become trendy to talk about social care settings as though they are democracies but this is a misrepresentation. It’s true that we should always have an eye on the rights of service-users but this doesn’t mean that organisations should abandon control of their systems. We need to maintain firm boundaries.

Firm Boundaries

Ask any parent what happens when adults who share responsibility for a child have different boundaries and rules. Ask any worker how they react when they have to work with two or more managers (perhaps on a rotating shift pattern) who have different approaches. Think about your own reaction to varying and conflicting sets of rules.

Now think about the different ways that your colleagues approach ‘problem behaviours’ at work. In every case you’ll find that different colleagues face different types of behaviours’ based upon their particular responses to them. It’s cause and effect.

If you do the same things, you get the same results.

If our job is to help people move beyond their behaviours’ and the need for our services then we must ensure that the experiences we give them are both appropriate and consistent. This means a whole team approach.

No ‘Pedestals’ and Staff Safety

A common problem with inconsistent care is the divided perception of workers it creates. Staff who don’t ‘toe the party line’ as it were typically appear to the service-users as more compassionate. They also tend to appear weak because they are easily manipulated but that’s not the issue for the moment. They appear compassionate.

By contrast other staff who do their jobs properly are seen to be less compassionate when compared with the weaker staff member. This can breed resentment toward the more professionally minded workers and even put them at risk of assault or malicious allegations. In the end neither staff member comes out well and the service user’s care becomes inconsistent too. Everybody loses when staff try to put themselves on a pedestal of compassion.

The other big problem is that if you climb on to a pedestal you also gave to keep it clean. If you acquire a reputation for being a ‘soft touch’ the negative or potentially explosive reaction you get when you do eventually stand firm will be far worse as a result.

Effective, Consistent Care

The point about effective and consistent care has already been made and does not need much restatement here. However it is, of course a major reason for ensuring a whole team approach.

If You Can’t Stop The Person Behaving Poorly, You Can At Least Stop Them Doing It To You

Health and social care workers are not supposed to be able to save the world. Some service users behave poorly for reasons that are way beyond our influence or control. For example we will not necessarily stop a grown man being violent if he learned to be so in the schoolyard 30 years earlier and has lived that way ever since.

However, clear and consistent boundaries will go a long way to ensuring that they behave differently toward you and your colleagues.

Contrary to popular belief people aren’t ‘just violent’ or ‘just rude’ or ‘just’ anything. Human behaviours’ are the result of complex equations involving costs and benefits, social norms, consequences and degrees of acceptability.

Think about the people you know who are offensive but hide their insults through humour. Did you ever ask yourself why they do that?

Usually this sort of behaviour (one of several forms of passive-aggression) is only there because outright aggression and hostility isn’t worth the price. Either the group norms forbid open hostility or the victim of their venom is just too scary. So they hide behind humour instead.

There’s a valuable lesson there. People tend not to behave in ways that are too dangerous to them. Clear boundaries will make it too dangerous for potential abusers to aim their abuses at you. That won’t stop them from behaving badly toward others but that’s not within your control. We have a legal system (or if appropriate a mental health act) for that.

‘Corporate’ Identity – “You’re All The Same.”

Every worker has experienced blame for the actions of a colleague. We’ve all found ourselves faced with an angry service user or relative because of some other worker’s actions. That’s because in the eyes of many of the people we work with we really are all the same. The wrongs they perceive from one of us might as well have been perpetrated by any of us.

So a good, firm team agrees standards of behaviour and everyone sticks to them. That way we all know what to do, what to expect and how to deal with the inevitable conflicts that our work involves.

Or you could make your work harder and less effective if you prefer.

Remember…….

If you do the same things, you get the same results

 

Privileged glimpses 16: Support is meaningless all by itself

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

SupportThe word ‘support’ is meaningless in and of itself. Not the activity – just the word. It’s meaningless for care providers to talk about support unless they then go on to say what they will actually do – what ‘support’ means in this context. Does it mean sending a letter of approval to the local paper, clapping or simply smiling benignly? Or does it mean something more tangible?

In my training I often ban the word altogether. That gets people actually to think instead of just trotting out tired old cliches. It’s sad to see how many people will confidently state that they’ll offer support as though that solves the problem but when pressed have no idea about what is really required.

Support is a nice, warm, fluffy word but in itself it doesn’t really mean anything more than good intent.

If you work in social care or health care then let me make a suggestion. Stop saying ‘support’ because it lulls us into a false sense of competence and when other people use the word immediately stop them and ask them just what that support will be.

Oh yes – and be prepared for some very experienced and knowledgeable looking people to be unable to answer you.

Sad isn’t it?

Privileged glimpses 14: You’re probably not an emergency service

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

In the last post we covered the saviour fantasy and the importance of sticking to what we know, what we’re trained for and what we are equipped to do. This post has a similair theme but with far more obvious consequences. But before we get into that let’s begin with a little definition.

In the social care context an ‘emergency’ is something that requires emergency services to deal with it. Non emergency staff may have a supporting role to play in the proceedings but they are not responsible for sorting out emergencies and they are not expected to place themselves at risk by ‘going in’ untrained, unequipped and unprepared.

Emergency services

If it doesn’t need emergency services it’s not an emergency. It may be something that’s better sorted out sooner than later but it’s not worth putting yourself or others at risk simply because other people don’t want to wait until it’s safe or until the appropriate staff are present.

If you work in healthcare the same basic rules apply although you may legitimately be the appropriate person to deal with it. If so you will have been trained to do so and you should know the limits of your responsibilities very clearly. If you’re not able to deal with the emergency then call someone who can.

Emergency services are:

  • Fire
  • Police
  • Ambulance
  • Coastguard
  • Mountain Rescue

All can be contacted by calling 999 or whatever internal emergency code your organisation uses (for example to summon the identified crash team in a general hospital).

If you’re a support worker in sheltered housing or a community care assistant for example then it’s not your job to deal with emergencies. Your job is to offer what assistance you can whilst help is on the way but only so long as it is safe to do so.

If you doubt this consider…

Would a fireman prefer to deal with one unconscious casualty or with one unconscious casualty and a disorientated amateur with no respirator or training in how to deal with smoke?

Would a paramedic prefer to deal with your injured colleague immediately or when you got around to calling 999 after trying to apprehend the assailant?

Would a policeman prefer to apprehend an assailant or deal with an assailant and organise help for a second vicitm as well?

Privileged glimpses 13: The saviour fantasy

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

There’s an irony about health and social care work. More specifically there’s an irony about health and social care workers. The workers who want to save the world are the ones most likely to cause harm, to themselves and to other people.

Saviour fantasistIn the trade we sometimes talk about the ‘saviour fantasy’. It’s an admirable quality in new and inexperienced staff but it’s unrealistic, dangerous and much less positive among more experienced workers. Those who come into this line of work expecting to make everything alright for everyone they meet tend to be committed and hard working. They have the potential to be excellent carers and advocates for those they work with. But those who hang on to their saviour fantasy over time demonstrate something else as well. Experienced saviours also demonstrate an inability to learn and that makes them dangerous.

We cannot please all the people all of the time. Nor can we ever know everything and we’re not able to do everybody’s jobs. It’s enough to ensure that we get our own part of the equation right. When we try to improve upon the work of others we risk meddling in what we’re neither trained nor sufficiently well-placed to understand.

Saviours are also much more likely to burn out themselves. If they expect only good things for their clients and take too much personal responsibility for ensuring positive outcomes for everyone they quickly become crushed when reality bites. There are many, many reasons why things don’t always work out in mental health care. Saviour fantasists blame themselves and the remorse they feel can be overwhelming.

Don’t be a saviour fantasist. It damages both service users and workers alike.

Privileged glimpses 12: Don’t flap

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

More haste – less speed.

There is a very real responsibility in social care work. The best workers are aware of that and strive to live up to it. They know that what they do matters and they take their work seriously.

Unfortunately though that sense of responsibility can become a problem in itself. The more seriously we take our duties the more likely we are to become stressed about them unless we also learn how to manage our own anxieties. Some of the most caring and compassionate people I know are also the ones most likely to turn into headless chickens the moment anything out of the ordinary happens.

The problem is that the more we flap the less effective we become. Our emotional over reaction is contagious too. If we lose our cool then our colleagues are more likely to do the same. Not only that, the people we care for are just as susceptible to displays of emotion themselves. Uncontrolled displays of anxiety from workers serve only to unsettle the environment even further. Instead of having one problem to deal with over anxious workers quickly find themselves stuck in the middle of a whirlpool of unrest and that just makes their work even more difficult. And they brought it upon themselves with their own lack of self control.

Perhaps more importantly it’s not fair on the people who rely upon us – the people in our care.

So the message here is simple. This ‘privileged glimpse’ really is bleedin’ obvious:

Don’t flap!

Privileged glimpses 10: Sympathy isn’t usually helpful

This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

I spoke with a colleague recently about a difficult situation she had to deal with at home. It doesn’t matter what the situation was. It’s enough to say that this lady considered that she was being treated unfairly and unreasonably by a family member. So far as I could tell (having heard only one side of the story) I’m inclined to agree.

The temptation was to sympathise with her. That often feels like the most human, most compassionate response to another person in distress. It’s how we show that we care, how we demonstrate understanding and, perhaps most importantly, it maintains rapport. When we sympathise with people we usually find ourselves ‘on their wavelength’ and that feels good.

Unfortunately though, however good it may feel sympathy is far from positive. In reality it’s usually very destructive. Here’s why….

When I sympathise with you I’m really telling you what you already want to hear. I’m reaffirming what you already think:

Sympathy empathy“Yes it is awful and you’re quite right to feel that bad about it.”

Sympathy locks us into the same emotions and beliefs as the other person and that’s not a good place to be. I can’t help you to move on and solve problems if I’m wearing the same emotional blinkers as you.

Of course, it is true that people really do have a right to feel bad when things don’t turn out as they would like them to. But it is also true that you don’t have to feel bad as well. You’re not obliged to join in.

If you resist the urge to sympathise you can keep a clear head without risking being drawn into the ‘doom and gloom’ thinking of the other person. This means that you will be free to explore other explanations and solutions. You can problem-solve and you can encourage others to do the same.

Sympathy acknowledges that people are right to feel bad and that traps them:

“Oh poor you. I’d feel awful if that happened to me.”

Empathy is a much, much more helpful proposition. Empathy acknowledges that people have a right to feel as badly as they want to but then it asks:

“But why would you want to?”

Empathy acknowledges and validates problems and emotions but then moves on to find solutions. Sympathy merely validates distress but offers no help to overcome it. In fact sympathy risks prolonging distress.

Don’t ‘do sympathy’.’ Do empathy’ instead.