Complexity
and Adversity Network Funded by QNIS in partnership with The Burdett Trust for Nursing About Programme Speakers Blogs Complexity and Adversity Network Funded by QNIS in partnership with The Burdett Trust for Nursing About Programme Speakers Blogs Relational Work in Primary Care Community Nursing Dr Sarah Doyle (Deputy Nurse Director, QNIS)
Dr Celeste Foster (Senior Lecturer in Mental Health Nursing, University of Salford) The primary task of nursing is relationships. And yet relationally important nursing interventions are sometimes difficult to see. The hardest work can often look like doing nothing: being receptive and attendant to all the ways people communicate with us, taking it in, finding ways to respond to it helpfully, whilst paying attention to and keeping under control our own feelings, is skilled work that takes emotional and psychological effort. In very deprived areas, the adversity people face and the complexity of health needs that must be addressed can make relational work more important and more difficult. Complexity and adversity can shut down everyone’s ability to think and our capacity for tenderness toward self and others, in favour of instinctive survival mechanisms. For example, people seeking care might behave in hostile ways and try to avoid engaging with services, while nurses might take refuge in practical tasks that create distance, prevent authentic human connection, and keep us so busy we don’t have time to pay proper attention to the person in front of us. We know that the populations served by primary care services in socio-economically deprived areas have much greater rates of adverse childhood experiences. This matters for later relationships, including engagement with primary care. Where early relationships were warm, responsive, and attentive then we are ‘primed’ for that experience to be repeated. But if those early relationships were cold, unpredictable, and destructive then we are more likely to expect that experience again. In those circumstances, small details count. Longer-term transformation and recovery often come from the repetition of tiny details of moment-to-moment care. Furnishing people’s hearts and minds with skills that will help them heal their own wounds, through relationships that provide a safe, reliable experience of being cared for, fans the embers of hope and belief in their own value. People can hold these experiences in mind long after the relationship they have with us (Foster, 2020). Working in healthcare, being alongside people who are in pain and distress, is emotionally demanding and nurses need to feel genuinely supported in order to operate in human and connected ways. Our programme of workshops offers resources and support to help maintain therapeutic optimism when working with complexity and adversity in deprived areas. They offer, a chance to develop detailed knowledge and skills for relational practice in everyday clinical work. Such expertise is central if we are to reduce our vulnerability to burnout and compassion fatigue (Foster, 2018) and avoid becoming unresponsive, or problematically responsive, to the emotional needs of the people and populations we serve. If you think you would like to learn more about CAN, you can find out more here. References Foster, C. (2018). Investigating professional quality of life in nursing staff working in adolescent psychiatric intensive care units (PICUs), The Journal of Mental Health Training, Education and Practice,14(1), 59-71.
https://doi.org/10.1108/JMHTEP-04-2018-0023

Foster, C. (2020). Caring for adolescents with acute and complex mental health needs in hospital settings: conceptualising and enabling nursing identity, task and intervention, PhD thesis, University of Salford.
http://usir.salford.ac.uk/id/eprint/59326 This blog also draws on material first published in our recent QNIS conference session summary, which you can read here: Shining a Light on the Invisible: Relationships and the Emotional Impact of Care