#HelloMyNameIs

 

“Hello, I’m Drew; I’m one of the nurses looking after you...”

This is how I always greet new patients, or patients’ relatives or carers, when I first meet them. I tell them who I am and what my name is. This is what I have always done, throughout my career, because it was the way I was trained to and because I always want to introduce myself, its only common courtesy.

I was horrified when I heard about the twitter campaign #HelloMyNameIs. It was started by Kate Granger, herself a doctor, who is undergoing cancer treatment.

My initial reaction was “Oh great, another patronising twitter campaign”, and I was about to dismiss it when I heard what was behind it.

While an inpatient, Kate Granger had experienced care and treatment from a whole string of different clinicians, none of whom had told her their name. Basically, they were anonymous strangers and they were delivering her care and treatment.

Knowing someone’s name is the beginning of forming a relationship with them. How many of our friends, how many of our colleagues do we know well and yet not know their name? We need to have a good, working relationship with our patients to be able to give them the best care we can. How can a patient trust us and open up to us if they don’t know our name? How can a patient trust a nurse’s clinical skill when they are giving them an injection or taking their blood when the patient doesn’t even know the nurse’s name? How can a patient open up to a nurse about the pain they’re in or the symptoms they’re having, especially embarrassing symptoms, when they don’t even know the nurse’s name? These questions can go on and on but they all boil down to the same thing, how can a patient trust us when they don’t know our name?

Our names are very important, they’re how we’re known to the world, they’re how people remember us and how they identify us. We know our patients’ names already, but by not giving them our own name we immediately set our working relationship as unequal, and we’re telling our patients to trust us when we don’t even trust them with our name.

What are we afraid of by withholding our names from patients? It creates such a poor image of nursing when we do this. How can we demand an open culture in healthcare when we aren’t being open with patients ourselves, when we don’t even tell patients our name?

My partner’s a Clinical Nurse Specialist. A few weeks ago, in the middle of the afternoon, he was carrying out a ward audit, which involved talking to patients about their care. He went up to a patient, told her his name and role, and explained why he was there. The patient then exclaimed; he was the first person to introduce himself to her all day.

How can we have good therapeutic relationships with our patients when we don’t tell them our names?

(This was originally published as a comment piece in Nursing Standard magazine in February 2015)

 

Postscript

I wrote the above out of shock and anger when I heard of the #HelloMyNameIs. I was so angry that there needed to be this campaign, why weren’t healthcare professionals already doing this?

That was eight years ago. Every NHS Trust now has its “Hello My Name Is” policy, or similar policies requiring staff to introduce themselves to patients, and everyone who has a patient-facing job, to any degree, wears an oblong, yellow badge, with their name written on it (like the picture illustrating this blog). So why am I resurrecting an old piece of writing, published years ago?

Over the last year, my situation has changed and I’ve been a patient far more than I’ve been a nurse. At first, I was shocked and now I’m just frustrated at the low percentage of healthcare professionals who introduce themselves to me, without being asked, telling me their name and job title. And I am really tired of the large number of them who get angry at me for asking, especially when I have to repeatedly ask them. They know so much about me, they know my name, age, and often a lot of my medical history, and yet I don’t even know their name. As I wrote above, it is impossible to trust someone who’s name I don’t even know. Also, when someone doesn’t give me their name, I always have the thought “what are you hiding?” I’m immediately on the defensive, what kind of bad care am I going to get from this person.

So many healthcare professionals seem to feel their yellow Hello My Name Is… badge is all they need, it does the job of introducing themselves, so they don’t have to do it. They can just get on with their jobs. But it isn’t a substitute, it doesn’t even come close to it. Even if you have good eye sight, those badges are not easy to read, especially when the person is already talking at you, and they don’t state the person’s job title.

I have seen the knock-on effect of this attitude too often, clinicians only seeing me as a collection of symptoms, as merely a task to be completed quickly, as only “a patient”, not as a person. And why should they go out of their way to help me? Why should they see me as an individual, instead of just the same as all the other patients? Why shouldn’t they just do their task quickly and move on from me? The nurse who conducted an assessment of me but didn’t take her eyes off the computer screen in front of her, not looking at me once. The clinician who shouted at me, “I’m not here for your benefit!” because I couldn’t lay flat being too breathless. The nurse who refused to help me, because she said she was too busy with paperwork, not even asking what help I needed. The Multi-Disciplinary Team (MDT) meeting, I wasn’t allowed to attend, where seven different consultants decided what treatment I would be considered for, but only one of those doctors had met me, and they couldn’t even get my symptoms right.

I would hope that those incidents wouldn’t have happened if those people had introduced themselves to me, but I just don’t know. I do know that they mightn’t have happened if those people saw me as a person, not as just a task or a group of symptoms.

“No Decision about me, without me”, was first coined in 2011 in the Department of Health consultation Liberating the NHS: No decision about me, without me. This was a call for shared decision making, where clinicians involve patients in clinical decision making, when deciding on treatment plans and options. Asking patients what they want from healthcare, what is their priority for their care. I remember this report because, at the time, it gave me a great phrase to remember, “No Decision about me, without me”. I was already working outside of the hospital environment and I’d already learnt the value of involving people with any decision about them, of discussing treatment plans with people, of tailoring it to their lifestyle and encouraging people to understand the need for it. I needed to work with the person because I was only seeing them once or twice a week and the rest of the time they would be managing their care, I needed to be working alongside the person.

But am I asking too much, am I being naïve? In our modern, busy, over-stretched and under-staffed NHS, do clinicians have enough time to introduce themselves to patients and listen to them? Do clinicians only have enough time to treat patients as tasks on a conveyer belt?

My GP practice is a typical, busy East London practice, with a turn-over of staff that can be sometimes breath-taking. But every time I see or speak to someone there, whether they are a doctor, nurse, pharmacist, paramedic or Healthcare Assistant, they always introduce themselves and tell me their job title. Even if it is only a five-minute telephone call, they always listen to me and act on my concerns. In return, I trust their care because of the way they treat me.

Am I really asking too much…

 

Drew Payne

“My Own Four Walls”

At the beginning of November I fell down a flight of stone steps at work, as I was leaving a patient's home and rushing on to the next one. As I fell my left foot was twisted back under me and I landed full on it, my full weight landing on my ankle and smashing it into a stone step. In that moment I fractured and dislocated my ankle in three lands.

Apart from a lot of pain, I had to have my ankle operated on to repair the fracture, it was too mangled to heal on its own, which has left me was a lot of metalwork holding my bones back in the right place. The worst part is that I had to have my leg and ankle in cast and be non-weight bearing for eight weeks (This is now week seven).

Once home I could hobble around on crutches but I couldn't leave the house. I am not very stable on the crutches, I can only walk on flat surfaces (The pavements here are far too uneven to safely hobble along on my crutches), and I can only walk for short distances because hopping along on these crutches is so damn tiring. Ten metres and then I need a rest. For the last seven weeks I have been house bound.

Being house bound has not been fun; it has been very frustrating and isolating. I am here, in this house, twenty-four/seven. My world has reduced down the sofa in the sitting room, and occasionally the toilet when I hobble out to it. My human company has been Martin, my partner, and the television. Martin works long days and is tired when he gets home, then he gets quizzed by me about what has happened during his day. Just hearing about the world out there makes me feel I am still part of it. I watch a lot of television, far more than I ever used to. The television doesn't just pass the time, though it does and that can help, but it tells me what is happening out there, it is another thread I can keep in touch with the world by.

But I never realised how isolating staying at home all the time is. I've had days off work, even weeks off work, but I have never been so long without the usual variety of people in my life. When friends telephone me I cling onto those telephone calls for as long as I can. I want to hear about their lives, what is happening with them. My news is so limited, how many different ways can tell someone that daytime television is so crap, but they have stories to tell and they have lives they can share with me and I want to hear everything.

I can spend hours on social media, surfing through Facebook and Twitter and Tumblr, because they are filled with other people's lives. Stories of what they have been doing, what they plan to do or sharing stories from yet other people's lives. I can read those stories, past comments and for a brief moment share in those people's lives.

I don't want anyone to think that this is a pity blog. In just under a week the cast on my leg finally comes off and I start being much more mobile. With mobility will come back independence and contact with the outside world. I will be able to leave our home and will eventually be able to return to work and my old life. Not everyone who is house bound has the same release from it.

I work as a District Nurse and my job is to provide nursing care for people who are house bound. For so many of my patients the only people they see, from day to day, are us District Nurses and their carers. They can be so lonely and crave contact. I will only have a limited amount of time to provide their nursing care (Give them their insulin or other daily injection, help them to take their medication, change the dressing to their wound, etc...) and they emotionally cling onto me, making conversation, asking me question upon question. I'm never cold or brisk with my patients, if anything I talk too much with them, nursing someone you become involved with their lives, especially with the patients we care for on long term. I was always aware of how isolating being house bound is, I have seen it so many times in the patients I have nursed.

Being house bound myself, even only for seven weeks, has forcefully reminded me how isolating and frustrating it is. We as humans are social creatures and most of us need the company of other humans, so why do we allow people to become so socially isolated just because they are elderly or their health is failing. In the last five years, under Tory austerity, council budgets have been slashed, we've seen many day centres and luncheon clubs for elderly people closed. Others have had their resources cut and so have had to cut the number of days people can use them, isolating more people in their homes.

We now have developed an attitude that people should stay in their own homes above all else, and that entering a care home is somehow a failure to be avoided. I have nursed so many people in their own homes who are almost prisoners of their homes, who would be far happier in a care home. In a care home there would be company for them, other residents to talk and socialise with. Staff would be available to meet their needs at their pace, not be rushed into the time bands allowed to District Nurses and carers. Instead they are confined to their own homes, grabbing what company they can from the limited time professionals visit them.

But are there enough care homes out there to meet people's needs even if we changed our attitudes? Care homes are full, good care homes have long waiting lists for them. We are not building enough good new care homes because the private companies who run them can barely make viable profits from the ones them currently run, there are very few incentives for them to open new ones. Also, care homes are not valued as places to work in. In nursing, working in a care home is still seen as professional failure, “Oh, you only work in a nursing home.”

In a week my cast will come off and I will finally be able to leave my home under my own steam. When I finally return to work, though, I will go back to caring for patients who are house bound without any end in sight. When did care of our elderly population become such a low priority?

Drew Payne