Civility - what has it got to do with nursing?

A slight departure from the chronology this week, with a reflection on an issue dear to my heart, civility. Civil behaviours convey a level of respect and courtesy to others that facilitate social co-operation and order.  They are as necessary for healthcare communities as they are for any other social community, tempering emotions in difficult circumstances and smoothing the way for people to communicate and work together effectively. As a cornerstone of good nursing practice, civility influences how patients and their families experience all aspects of the care they receive.  

At the other end of the spectrum, incivility conveys a lack of respect or tolerance for others, undermining the sense of common good that society needs to function effectively and peaceably. In healthcare, it can be at best irritating and at worst seriously destructive, impacting negatively on physical and mental well-being.  Whilst civility keeps the focus on the primacy of the patient experience, incivility allows judgement, bias and personal preference to intrude, often to the detriment of the patient. Nurses therefore have a professional and moral duty to behave with civility at all times and nurse education has a key role to play in the development of civil behaviours as part of professional formation. In essence it is about being nice to each-other and in nursing I think that has real significance for how we care for patients (and how patients feel they are being cared for).

 

My personal interpretation of civility and incivility is born of a collection experiences which have influenced my perceptions, attitudes and expectations in relation to how people behave to each-other. Some of these go back to my earliest experiences as a nurse and of course further back to my childhood. Raised in a polite family, we were taught the importance of writing thank you letters after receiving gifts, we went to Church to say thank you for having food on the table and we gave up our seats to older members of the family when asked to. After tea we asked for permission to leave the table, sat quietly whilst my father watched television and went to bed without arguing. At school teachers were respected and children, including myself, were well behaved. The same standards of civility were expected when I commenced nurse training, aged 19. Student nurses stood up when a senior nurse came onto the ward, addressed patients and colleagues by their title and surname and always took the stairs to leave the lift free for patients and relatives to use.

 

Variations in standards of behaviour became more obvious to me when I entered into adulthood. Not long after I started training I was admitted to my training hospital for an operation on my feet. Afterward I was lying on the bed with both feet plastered heavily, feeling sick and in a lot of pain, particularly in my toes. When the night nurse came on duty I asked her if she could put the bed cradle (a device to lift the sheet clear of a patient’s feet) in for me. She turned and told me that if I wanted it so much I could get up and get it myself. That nurse, an older and apparently experienced staff nurse left me feeling shocked and embarrassed (and everyone else in the four-bedded bay not daring to move a muscle). Needless to say I didn't ask again. I faked a bowel motion two days later and got out of there as quickly as is possible in a wheelchair with flat tyres and no foot plates (shortages in the NHS are nothing new). 

On another occasion, my Grandma, who had cancer, was admitted to the surgical ward whilst I was a student on placement in the nearby maternity unit. One morning I received a message to go up to the ward quickly because she was very ill and the rest of the family had been called in. She died whilst I was there and after the formalities had been dealt with I returned to the maternity ward to explain to the ward sister what had happened. She said nothing about my Grandma's death, just looked me up and down and told me not to come back on duty until I had a clear nasal swab because “we have no idea what germs you might have picked up on surgery”. Not surprisingly, midwifery didn't feel like a possible career option after that.

There were other incidents that came later, after qualifying as a nurse. Such as the man who came to the ward every week to visit his mother, drunk and verbally abusive or the consultant who swore in-front of an elderly patient because the nurses refused to strap a wooden plank under the patient’s leg to keep him still. There was also a more subtle but equally corrosive type of incivility. The vascular surgeon who introduced me to his team as the Bottom Nurse (I was a skin care specialist in Enfield by then) and the ward sister who called all her patients Sweetie Pie, regardless of age, ethnicity or gender. Ten years on, as a nurse educator, I continue to see all sorts of examples of incivility in my day-to-day working life; people talking over one another in meetings, students late to class, people blocking corridors, aggressive emails, smoking outside open windows.

I am shortly having a 'coffee and conversation' with colleagues to try and tease out what we understand by these terms, incivility and civility. After all perhaps my views are very different to those of others. Maybe its an age gap thing, or a culture issue, or a gender perspective.

 

Whatever it is, it is definitely something to think about...