STUDENT COLUMN
Saying the wrong thing Ed Freshwater discusses the perils of social media and the boundaries that separate compassion and professionalism.Whatever you do, he says, never add patients as friends on Facebook!
© 2015 MA Healthcare Ltd
S
ometimes, a kind word can make everything seem ok. Sometimes, the wrong word can make it all a million times worse. I got into a bit of trouble on Twitter recently. Someone asked for some feedback about something and—with me being ‘a vocal contributor’—I shared my opinion. It was not a positive one. In fact, I was quite critical and had a side-chat with a friend in public about what I thought. Not constructive, not particularly considered, but an honest opinion. And this caused a bit of upset, because the person didn’t like what I said, and the person is quite senior to me. In among all the opinions and the confidence of my new qualification and registration, I perhaps lost sight of my position as ‘merely a student’ compared with a senior manager. I didn’t really get my fingers burnt, but they were fairly well singed. Caramelised, perhaps. In clinical practice, I’ve said the wrong thing on a couple of occasions and it didn’t go down well. The first time I was trying, a bit clumsily, to have a conversation about personal hygiene with a teenager. This one young man had a very negative self-image and needed lots of support and encouragement. So when I talked about making sure he washed himself before going out, he took offence because he thought I thought he was smelly. Another time, I was chatting with a different young service user informally in the ward lounge. We were having a conversation about his upcoming community leave that clearly meant a great deal to him and he was experiencing some anxiety about it. I was, completely unconsciously, smiling. He thought I was smirking because I thought he was stupid, and took great offence. Our therapeutic relationship was significantly damaged and took several weeks to restore. Reflecting on this incident now, I’m glad I had the time to make amends in this regard; if he had been an outpatient, the damage caused
British Journal of Nursing, 2015, Vol 24, No 9
could have resulted in him disengaging from his care and so I feel a weight of responsibility going forward. As a mental health nurse, the absolute foundation of my craft is to establish a solid and respectful therapeutic relationship—an honest, but definitely one-sided, friendship in which the service user can honestly and openly share his or her deepest feelings and thoughts, dreams and nightmares. It’s a ‘onesided’, or unbalanced, relationship because I have to maintain my professional distance and rigorous boundaries—to do otherwise could be dangerous for me and my family, which I’ll come to—and so it’s distinct from a friendship but shares many of the same characteristics. In my admittedly short experience, I have found that trust in a relationship is very hard won but easily lost in a moment of carelessness. The broad concept of professionalism is one I reflect on often and continue to struggle with. How can I maintain a balance between being a genuine practitioner (person, even)—demonstrating empathy, warmth and compassion—with maintaining that little bit of professional distance and being ‘clinical’, almost dispassionate? In our classes on professionalism at university, it was a frequent debate, as we explored where that line had to be drawn. As professionals, we represent not just our own opinion, but our wards, supervisors, hospitals, trusts and the profession of nursing on a daily basis. Think of those who abused patients at the now infamous Mid Staffordshire NHS Foundation Trust—that’s who we remember, not the ones who turned up and did an excellent day’s work. The bad things people do as nurses stick in the public consciousness and taint the entire profession. Before you know it, politicians are shouting from the rooftops that nurses have lost sight of compassion, that they have become uncaring and callous, and concerned only with their pay cheques and weekend plans.
By the same token, I have met nurses who went too far the other way, caring so much for the patients that it began to affect their personal lives. Some people add patients as friends on Facebook—just in case no-one else has said it, please don’t do that—while others arrange to meet up socially or share phone numbers. This can cause stress and anxiety because you’re taking your work life home with you, and you are then open to the charge of unprofessional behaviour from colleagues and families (your own and the service user’s). Mind you, I know of one doctor who started seeing a former patient socially, and I’m glad they did or I wouldn’t have been born… Reflecting on these times when I’ve said the wrong thing, I’ve been surprised at how fragile some of those relationships were. The two young service users I mentioned had been in my care for a number of weeks, and we spent long periods of time talking through problems, diagnoses, medication and therapy. It was surprising that, in an unguarded moment, all that work counted for nothing. On the other hand, these were young people who had experienced significant emotional trauma in their lives, and I can hardly expect them to react the same way I would, being twice their age! Maybe there’s no way to fully prevent this kind of thing happening, but I can console myself that at least it bothered me enough to try and resolve the relationship. After all, as a nurse, the last thing I want to do is walk away. If I did, then I couldn’t really say I care at all. As for Twitter, I was reminded by a friend the other day that with just 142 characters it’s almost impossible to articulate a context. In other words, it’s the perfect environment for BJN saying the wrong thing!
Ed Freshwater,
3rd year student, BSc Mental Health Nursing, Birmingham City University. 497
British Journal of Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 12, 2015. For personal use only. No other uses without permission. . All rights reserved.
Saying the wrong thing Ed Freshwater discusses the perils of social media and the boundaries that separate compassion and professionalism.Whatever you do, he says, never add patients as friends on Facebook!
© 2015 MA Healthcare Ltd
S
ometimes, a kind word can make everything seem ok. Sometimes, the wrong word can make it all a million times worse. I got into a bit of trouble on Twitter recently. Someone asked for some feedback about something and—with me being ‘a vocal contributor’—I shared my opinion. It was not a positive one. In fact, I was quite critical and had a side-chat with a friend in public about what I thought. Not constructive, not particularly considered, but an honest opinion. And this caused a bit of upset, because the person didn’t like what I said, and the person is quite senior to me. In among all the opinions and the confidence of my new qualification and registration, I perhaps lost sight of my position as ‘merely a student’ compared with a senior manager. I didn’t really get my fingers burnt, but they were fairly well singed. Caramelised, perhaps. In clinical practice, I’ve said the wrong thing on a couple of occasions and it didn’t go down well. The first time I was trying, a bit clumsily, to have a conversation about personal hygiene with a teenager. This one young man had a very negative self-image and needed lots of support and encouragement. So when I talked about making sure he washed himself before going out, he took offence because he thought I thought he was smelly. Another time, I was chatting with a different young service user informally in the ward lounge. We were having a conversation about his upcoming community leave that clearly meant a great deal to him and he was experiencing some anxiety about it. I was, completely unconsciously, smiling. He thought I was smirking because I thought he was stupid, and took great offence. Our therapeutic relationship was significantly damaged and took several weeks to restore. Reflecting on this incident now, I’m glad I had the time to make amends in this regard; if he had been an outpatient, the damage caused
British Journal of Nursing, 2015, Vol 24, No 9
could have resulted in him disengaging from his care and so I feel a weight of responsibility going forward. As a mental health nurse, the absolute foundation of my craft is to establish a solid and respectful therapeutic relationship—an honest, but definitely one-sided, friendship in which the service user can honestly and openly share his or her deepest feelings and thoughts, dreams and nightmares. It’s a ‘onesided’, or unbalanced, relationship because I have to maintain my professional distance and rigorous boundaries—to do otherwise could be dangerous for me and my family, which I’ll come to—and so it’s distinct from a friendship but shares many of the same characteristics. In my admittedly short experience, I have found that trust in a relationship is very hard won but easily lost in a moment of carelessness. The broad concept of professionalism is one I reflect on often and continue to struggle with. How can I maintain a balance between being a genuine practitioner (person, even)—demonstrating empathy, warmth and compassion—with maintaining that little bit of professional distance and being ‘clinical’, almost dispassionate? In our classes on professionalism at university, it was a frequent debate, as we explored where that line had to be drawn. As professionals, we represent not just our own opinion, but our wards, supervisors, hospitals, trusts and the profession of nursing on a daily basis. Think of those who abused patients at the now infamous Mid Staffordshire NHS Foundation Trust—that’s who we remember, not the ones who turned up and did an excellent day’s work. The bad things people do as nurses stick in the public consciousness and taint the entire profession. Before you know it, politicians are shouting from the rooftops that nurses have lost sight of compassion, that they have become uncaring and callous, and concerned only with their pay cheques and weekend plans.
By the same token, I have met nurses who went too far the other way, caring so much for the patients that it began to affect their personal lives. Some people add patients as friends on Facebook—just in case no-one else has said it, please don’t do that—while others arrange to meet up socially or share phone numbers. This can cause stress and anxiety because you’re taking your work life home with you, and you are then open to the charge of unprofessional behaviour from colleagues and families (your own and the service user’s). Mind you, I know of one doctor who started seeing a former patient socially, and I’m glad they did or I wouldn’t have been born… Reflecting on these times when I’ve said the wrong thing, I’ve been surprised at how fragile some of those relationships were. The two young service users I mentioned had been in my care for a number of weeks, and we spent long periods of time talking through problems, diagnoses, medication and therapy. It was surprising that, in an unguarded moment, all that work counted for nothing. On the other hand, these were young people who had experienced significant emotional trauma in their lives, and I can hardly expect them to react the same way I would, being twice their age! Maybe there’s no way to fully prevent this kind of thing happening, but I can console myself that at least it bothered me enough to try and resolve the relationship. After all, as a nurse, the last thing I want to do is walk away. If I did, then I couldn’t really say I care at all. As for Twitter, I was reminded by a friend the other day that with just 142 characters it’s almost impossible to articulate a context. In other words, it’s the perfect environment for BJN saying the wrong thing!
Ed Freshwater,
3rd year student, BSc Mental Health Nursing, Birmingham City University. 497
British Journal of Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 12, 2015. For personal use only. No other uses without permission. . All rights reserved.
