In the first of two blog posts, Catherine Kelsey opens up a discourse about the challenges that surround the nursing profession in understanding not only what it means to experience illness, but also the importance of developing a truly humanistic approach to nursing care.
As nurses we must not lose sight of the patient as a human being and therefore it is essential that we utilise a plethora of communication skills that open up ‘a window of opportunity’ for patients to tell their stories of suffering and personal experience, a process that promotes patient empowerment and nurtures personal growth and resilience (Drumm 2013). Empowering patients to tell their stories can enable the delivery of high quality, collaborative person-centred care, including end of life care, encourage greater understanding and foster empathy and reflection (Drumm 2013).
A plethora of definitions exist to describe the humanities within healthcare. Synonymous with health humanities, medical humanities has been defined by Cole et al. (2014) as both an interdisciplinary and multidisciplinary field that explores contexts, experiences and critical theories within medicine and healthcare, whilst supporting the formation of professional identity. The ideology of medical humanities proffers significant opportunity for strengthening professional and humanistic growth in the medical profession (Shapiro et al., 2009). In contrast, it is argued that nursing humanities is concerned with the lived human experience (Lazenby 2013) and the clinical ‘as a catalyst of healing’ (An-Bang Yu 2014). Although in recent years there appears to have been a revolution in promoting the humanities within medical training, the same cannot be said of nursing, perhaps due to the conventional view that nursing is considered to be the ‘caring profession’ (Dellasega et al., 2007). Despite the imbalance of science v the art of nursing, contemporary nursing practice continues to emphasise the predominance of nursing being a clinically evidence-based research profession, (McKie 2012) rather than fostering a deeper quality of the humane relationship between the patient and healthcare professional (Chiapperino and Boniolo 2014). With the drive for new professional roles in nursing, an example of which is the advanced nurse practitioner (RCN, 2012), it could be argued that there is a potential danger that the singular focus will be on the diagnosis, rather than on the patient as being human with feelings and emotions, and in so doing fail to recognise the nurses’ role as that of a humanitarian.
Despite this concern, Chiapperino and Boniolo (2014) opine that the diverse disciplines of both medicine and nursing are implicit in cultivating a significant appreciation of what it means to be human and how illness is experienced. Carel (2013) argues that illness is considered a specific component of what it means to be human and raises important philosophical issues. Rather than view illness as a scientific entity, she argues, it should be considered as a lived event. Fundamentally, being able to demonstrate a humanistic approach towards others involves both the expression of sincere empathic behaviours and the ability to listen effectively (Baum 2002). Furthermore, it requires the capacity to engage with patients; to interpret information and to communicate appropriately (Oyebode 2010). Through the understanding and interpretation of illness these humanistic skills can be utilised in order to diagnose, prognose and deliver direct effective care, whilst recognising the existential damage the illness can cause (Martignoni et al. 2012). The emphasis however should not simply focus on the technological aspect of healthcare provision and the treating of patients but also on the human aspect, which acknowledges that patients present with a gamut of ‘reactions and emotions that affect their experience with illness’ (Hart 2011).
Greater emphasis is now being placed on understanding the observed phenomenon of patients suffering from both physical and mental health conditions, with evidence now strongly indicating that those patients who have poor physical health are also at risk of poor mental health and vice versa (Naylor et al. 2012). In view of this, healthcare professionals need to facilitate a greater understanding of the psychological functions and the relationship that exists between the mind and the body (Martignoni et al. 2012).
The biopsychosocial model (Engel 1977) is a useful framework in helping to facilitate this. However, a word of caution is necessary, for even though the professional quality of empathy, for example, is a greatly respected complement to the biopsychosocial approach, empathy decline is a phenomenon that appears early within healthcare students, as the change from ‘idealism to realism’ emerges (Nunes et al. 2011). Disappointingly this ‘decline’ has the capacity to reduce the effectiveness of Engels’ (1977) model at a time when it is perhaps needed the most. In a society in which an ageing population requires an increasing amount of care – whether, medical, nursing or social – this represents a significant problem to the delivery of contemporary healthcare provision and is one that requires urgent consideration.
The second of Catherine Kelsey’s blog posts is ‘Improving the Chances of Person-Centred Nursing Care’, and you can read it here.
References
An-bang Yu (2014) ‘The Encounter of Nursing and the Clinical Humanities’, Nursing Education and the Spirit of Healing 3: 660–674.
Baum, M. (2002) ‘Teaching the humanities to medical students’, Clinical Medicine 2 (93): 246-249.
Carel, H. (2013) The Lived Experience of Illness. Faculty of Arts, University of Bristol.
Chiapperino, L. and Boniolo, G. (2014) ‘Rethinking Medical Humanities’, Journal of Medical Humanities.
Cole, R.T. Carlin, N.S. and Carson, R.A. (2014) Medical Humanities. An Introduction. Cambridge University Press: New York.
Dellasega, C. Milone-Nuzzo, P. Curci, K.M. Ballard, J.O. and Kirch, D.G. (2007) ‘The humanities interface of nursing and medicine’, Journal of Professional Nursing 23 (3), 174-179.
Drumm, M. (2013) The Role of personal Storytelling in Practice. The Institute for Research and Innovation in Social Services; Glasgow.
Engels, G. (1977) ‘The need for a new medical model: a challenge for biomedicine’. Science, New Series 196 (4286): 129-136.
Hart, J. (2011) Teaching Humanism in Medical Training. Alternative and Complementary Therapies.
Lazenby, M. (2013) ‘On the humanities of nursing’, Nursing Outlook 61 (1): e9-e14.
Martignoni, G. Grignolia, N. Di Bernardo V. Malacrida, M. Bernegger, G. Barazzoni F. and Malacrida, R. (2012) ‘Medical Humanities: a question of style’, Critical Reviews in Oncology/Hematology 84, (2): 1-4.
McKie, A. (2012) ‘Using the arts and humanities to promote a liberal nursing education: Strengths and weaknesses’, Nurse Education Today 32: 803-810.
Naylor, C. Parsonage, M. McDaid, D. Knapp, M. Fossey, M. and Galea, A. (2012) Long-term conditions and mental health. The cost of co-morbidities. King’s Fund, London.
Nunes, P. Williams, S. Bidyadhar, Sa. and Stevenson, K. (2011). ‘A study of empathy decline in students from five health disciplines during their first year of training’, International Journal of Medical Education.
Oyebode, F. (2010) ‘The medical humanities: literature and medicine’, Clinical Medicine 10 (3): 242-244.
Royal College of Nursing (2012) Advanced Nurse Practitioners. An RCN guide to advanced nursing practice, advanced nurse practitioners and programme accreditation. RCN: London.
Shapiro, J. Coulehan, J. and Wear, D. (2009) ‘Medical humanities and their discontents: definitions, critiques, and implications’, Academic Medicine 84 (2): 192-98.