A couple of videos have made me think recently about how we view inbed care.
The first was a video in which physicists from the University of Paris-Sud’s Laboratory of Solid State Physics discuss a cup of coffee in front of them. They each share and explain something different about it – what causes it to get cooler; why the cup is white (as opposed to the coffee being black); the fluid mechanics of the coffee, etc. Each is valid and based on their area of specialism and perspective yet by all being research physicists they want to understand how they interrelate.
The second was an extract from ‘What do you see?’, a poem written from a patient’s perspective asking what her carers see when they care for her. It highlights that they might see an ‘old crabby lady’ who is unable to communicate or move; rather than the person she still feels – an individual living life with loves and hopes.
These videos made me realise that everyone involved in inbed care has a different perspective too. Doctors want to treat patients. Nurses want to care for patients. Manufacturers want to make and sell the types of equipment that hospitals use. Patients want dignity; to be cared for safely and to get better and leave. With each stakeholder pursuing their own priorities however leaves little opportunity to stop and consider how they all fit together. They are trying to get their systems to work more efficiently without considering if they are actually trying to improve the right thing.
Russell Ackoff explains that this might be the reason why significant change is difficult. He reasons that there are 5 types of hierarchical content in the human mind – data, information, knowledge, understanding and wisdom. The first 4 relate to efficiency whilst wisdom relates to effectiveness. He goes on to use Peter Drucker’s explanation that there is a difference between doing things right (efficiency) and doing the right thing (effectiveness). He reasons that every major social problem is a consequence of “trying to do the wrong things righter”. With wisdom however comes the drive to re-examine what is ‘the right thing’ so that objectives are realigned and significant change can be made.
It’s easy to measure what we are currently doing. It’s hard to measure the effect of something not yet being done or how much has been improved/ saved through a prevention approach. However, just like the physicists appreciating each other’s views of the coffee cup so we need to look at all the different aspects of inbed care. One in particular stands out for me: Patients want to be cared for safely and to get better and leave. Of course, some have terminal illness but whatever their situation, no-one wants their care to be the cause of an additional problem.
In the optical illusions above, people will either see a duck or a rabbit first in the left hand image. Similarly, in the right hand image, they will either see an old crabby woman or an elegant lady first. In each optical illusion, only one of the images – e.g. the duck or the rabbit – can ever be seen at a time (ie not both at the same time) and once both options in the illusion have been identified, a person’s perception moves back and forth between the two images. They cannot decide to ‘unsee’ one; moving forward they will always be able to see both. Paul Kah considers this and Wittegenstien’s view? and concludes that each view point “will determine a set of expectations and connections – uses – that will sustain different forms of enquiry responsive to different questions and moving in different directions. The image does not change, but the world within which it has meaning changes.”
So just like the physicists explored different aspects of the coffee cup, so research around wounds, wound care, tissue harm and force related tissue damage (aka pressure sores; tissue ulcers etc) bring many different viewpoints. For progress to be made, more needs to be done to explain and show their interconnectedness.
We need to look at the interconnectedness from classical relativity through to a quantum theory of our physical world; of our tissues and cells and how they protect us from harm whilst being stabilised, moved and repositioned when being nursed inbed.
Accepted practices and products tend to err towards a ‘disability and sickness system’ rather than a preventative healthcare system. Therefore in Bucky Fuller’s words, “to change the way people think, don’t tell them what to think, give them a tool the use of which will change the way they think”. For us, this tool is research and forums in which they can be discussed and applied.
When creating the conditions to foster emergent learning in organisations, Sahana Chattopadhyay believes that they need “to build the capacity to have such conversations where individuals and teams ‘hold space for something new to be born.’ This requires completely shifting away from all preconceived ideas, old solutions, yesterday’s logic, and past patterns. Suspending everything we thought we knew. Only from a place of listening to each other, to the context, and to the information flowing in the ecosystem with an open mind, open heart, and an open will, can we learn what wants to emerge.”
Only then will tissue harm be prevented and the patient’s objective met of getting better and leaving – or in the very least avoiding additional problems caused whilst being cared for.