By reaching out we In their fourth article on the social sciences, nursing lecturers Iain Atherton and Richard Kyle explain how engagement can stop nurses feeling helpless


Our first article on the social sciences opened with a shocking statistic: a child born in Sierra Leone is likely to live only half as long as a child born in the UK. That was before Ebola. Just two weeks after our article appeared in print, the World Health Organization’s (WHO) first situation report on the Ebola epidemic in west Africa noted that, since January 2014, more than 1,000 people in Sierra Leone had contracted Ebola and that two in five had died. In the 78 days between that first report and WHO’s latest one, an average of 58 people have contracted Ebola every day in Sierra Leone. Now, more than 7,000 people have contracted the disease and one in five have died. Incidence continues to increase.

At a state hospital in Kenema, Sierra Leone, a nurse dons a special uniform and mask as protection against the Ebola virus

The Ebola epidemic has forced many nurses to face the limits of their power to help. But our feelings of empathy can be used to spark more local engagement with the people we help. Author Iain Atherton and Richard Kyle are readers in the school of nursing, midwifery and social care at Edinburgh Napier University

Ebola’s impact will echo for generations. UNICEF has already warned that the epidemic is starting to reverse child and maternal health gains made in Sierra Leone in recent years. The life expectancy of the country’s children is likely to fall further still. In the face of an epidemic of this magnitude, it is easy to feel like helpless onlookers to others’ distress. What can we do? How can we engage with this? As nurses, with hands that help to heal on a daily basis, Ebola forces us to face the limits of our reach. Empathy forbids us from turning away, yet distance prevents us from drawing close to those for whom we long to care. Global epidemics such as Ebola, SARS and HIV/AIDS challenge us to think about how we can scale-up the scope of our concern and our

practice. Scholars such as Benny Goodman have encouraged nurses to do that by reflecting and acting on the public health challenges presented by climate change.


Yet, just as the maxim of the green movement prompted us to ‘think globally, act locally’, we believe that the idea of biogeography we are exploring through these articles encourages engagement in the lives of others. It exhorts and enables us to act in the world around us at various scales, from the local to the global, opening possibilities to overcome our apparent paralysis. In our last article we discussed empathy as a foundation for a revolution in nursing. We suggested that finding ways to step into the shoes of others brings

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new understanding of the ways in which societal structures shape personal circumstances, choices and life chances. But empathy is only the first step. Empathy sparks engagement, and engagement is about actively and positively shaping the places where our patients live. If empathy is about seeing people as more than patients, engagement is about extending the reach of our concern to people before they become patients. Engagement encourages us to shift our attention upstream to understand and also practically and positively change those factors that curb opportunity, constrain choice and, ultimately, influence people’s health. How can engagement make a difference to our day-to-day nursing practice? We believe engagement extends our care and concern in three ways:

Personally It develops a sense of our place in the world. Engaging with the world locally and globally broadens and challenges our understanding. It makes us more rounded individuals, enhancing our care. Professionally It enables nurses to embrace the full scope of their role. Engaging with the habitats that shape health is often the preserve of the public health nurse. Drawing closer to these environments enables nursing as a profession to play a pivotal role in prevention as well as treatment of ill health. Practically It encourages us to think about how we prioritise the care we provide. Engagement in communities increases awareness of the availability of supportive services, or the local obstacles to healing, recovery and rehabilitation. This may then shape the decisions we make while delivering care. For example, we might delay performing a specific task to instead prioritise contacting others in the hope that we could overcome such an obstacle (see case study).

Next steps

Leaping into the lives of others to make a meaningful difference may well be seen as a lofty ideal. But small steps taken regularly and rapidly over time soon build towards something significant: the ability to overcome the limits of our reach. So, in the face of a seemingly insurmountable challenge, start small. List the issues that you feel powerless in the face of: Ebola, climate change, poverty. Think about small steps you could take to overcome this paralysis, such as raising

awareness, lobbying government and getting involved with local and national charities. Could local community groups harness your skills to change communities and lives? Sharing our lives with others starts the process of building relationships. Through this, empathetic understanding is built. But learning to see patients in their own world is just the start: the point is to change their world for the better NS To read the other articles in this series go to

HOW JACK’S WORLD CHANGEDSUE’SPRACTICE It has been almost a year since Sue, a nurse, first met Jack, a local man who for many years had struggled with drug addiction. Over time, through conversation, Sue gained insight into Jack’s world. Her eyes were opened to the ease with which drugs could be bought in her home town, the extent of local homelessness and aspects of Jack’s world hidden from her own experience. She learned how local landlords had manipulated rent laws to reap profit from people when they are at their most vulnerable. It stirred Sue to act. She engaged with the local branch of a national homeless charity. Through meetings and discussion with others, she increasingly became aware of a variety of evidence on the importance of secure tenancy to help people address drug addiction. As a result, her practice changed. Before she first met Jack, she would rush to the medical task in hand. After meeting Jack, she paused to consider whether the social response might be more pressing, such as liaising with local authority housing officers to arrange accommodation that supported recovery.



can change worlds

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By reaching out we can change worlds.

The Ebola epidemic has forced many nurses to face the limits of their power to help. But our feelings of empathy can be used to spark more local engag...
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