Promoting excellence in community nursing across Scotland
Complexity and Adversity in Primary Care Community Nursing
Dr Sarah Doyle (Deputy Nurse Director, QNIS) Dr Carey Lunan (Deep End GP & Chair, Craigmillar Medical Group)
Scotland’s Deep End GPs have argued for a long time now that providing health care in deprived areas requires a special blend of tenacity, skill and compassion because the clinical work is ‘characterised by high volumes of alcohol and drugs misuse, multi-morbidity, psychological distress, poly-pharmacy, child protection issues and social problems’ (Blane 2018, p. 256). Workloads are often greater, and more complex. Consultation rates are higher, consultation times are shorter, and there are higher levels of early multi-morbidity in the populations cared for, with lower levels of health literacy and enablement. Social complexity infuses many clinical encounters and practitioners report higher levels of burnout. There are often challenges with recruiting and retaining clinicians in socio-economically deprived areas and these factors combine to propagate the ‘inverse care law’ where access to healthcare is often poorest for those who need it the most. And yet, the time needed for each visit and consultation tends to be longer due to the combination of complex health and social factors affecting people’s lives.
As well as realistic responses to the need for sufficient workforce numbers, it is crucial that staff have the time and space to recognise and manage the emotional impact of their work. It can be difficult for clinicians to understand and navigate the complex interpersonal relationships that can arise when delivering healthcare in more socio-economically deprived settings. People being offered care are more likely to have experienced significant adverse childhood experiences and other trauma, and this can impact their ability to trust caregivers. This can be experienced as rejection, sabotage, hostility or ‘non-engagement’ by clinicians and can erode our ability to retain compassionate practice or work in these more challenging areas if not fully understood. Yet being open to authentic emotional connections is essential if we are to work in relationship-oriented ways that genuinely benefit people and communities. It is also the reason that many of us entered the healthcare profession in the first place.
Thanks to funding from the Burdett Trust for Nursing, QNIS is offering an exciting programme of online workshops for community nurses and midwives working in primary care in deprived areas. Building on the work of Scotland’s Deep End GPs, the workshops will focus on the importance of the relationship between the person receiving care and the person providing it. By drawing on contemporary psychodynamic ideas, the workshops will deepen participants’ abilities to understand how this relationship works, make sense of all the things that influence it, figure out how to respond in ways that strengthen it and help support us in the work we do.
Many of those supporting and contributing to this programme of workshops have found that psychodynamic ideas help us sustain more thoughtful and reflective ways of providing care. And just as important, learning more about our relationships with others also helps us pay attention to our own psychological needs. Professionals providing care are people too. Having skilled support and well-facilitated space to think can make the difference between drowning and flourishing in our work. If you think you’d like to attend, find out more here.Reference
Blane, D. (2018) Medical Education in (and for) areas of socioeconomic deprivation in the UK.
Education for Primary Care, 29:5, 255-258.