Saturday 14 November 2009

The Left Brain and the Crisis in Nursing

One of the features of our times (don't you just hate it when a post begins like that? But bear with me...) is an increasing detachment from reality. It takes many forms - from the growth of pseudosciences like economics, sociology, evolutionary psychology and (God help us) 'management' to the increasing preference for virtual worlds over the real one and for isolation over society, the denial of the physical realities of life and especially death, an increasingly distant, sanitised relationship with nature, and so on and on - the list is endless. One of the manifestations of this flight from reality is all too apparent in the workplace, where a fixation on process and regulation has led to a climate in which, in ever more fields of activity, people are busier than ever, but the actual doing of the job, in the sense of the activity that is supposed to produce the desired outcome, is all but marginal. Nursing is a classic case, and one that can affect us in peculiarly painful, life and death ways. One hears all too often of wards where nurses spend all their time glued to computer screens or in meetings, leaving the actual business of what used to be known as nursing, i.e. looking after patients, to juniors, nursing assistants or short-term agency staff (and I've seen this for myself often enough to know it's not mere anecdotal grumbling). Basics such as cleaning, patients' hygiene and bed care, even feeding - let alone good manners or reassurance and solace - are neglected, while the business of 'nursing' goes on at a level that apparently has little or nothing to do with the actual hands-on care of the patient. And now there's a serious proposal to make nursing a 'graduate profession', thereby divorcing it even further from reality and paving the way for a future when no 'nurses' will actually nurse.
How have we come to this pass? The author of this interesting book suggests a neurological explanation: the left brain - detail-oriented and favouring mechanical systems over living organisms - has become increasingly dominant over the right, the hemisphere that, with its 'breadth, flexibility and generosity', has a better grasp of living reality in all its mess and mutability. Well, he may be right - though I'm inclined to doubt that it's a sufficient explanation - but if he is, that begs the question Why? Why this increasing left-brain dominance? Is there an evolutionary explanation? If there is, it would seem to be one of those evolutionary processes that is, somewhat paradoxically, driving us in the direction of self-destruction - and, in the workplace, away from the common sense and informal exercise of professional judgment that were by no means infallible but at least tended towards getting the job done.
By the way, can anyone answer this one? If you're left-handed, does that mean that your right hemisphere is dominant, and does it have the same nature as the right hemisphere in a right-handed person's brain? If we left-handers are indeed 'right-brained', then clearly it's time we took over the world...

19 comments:

  1. A subject close to my Victor Meldrew side Nige. Spent most of my life organising the making of things, that most tactile of earners, manufacturing. In forty years this process became so dominated by computer control that the number of bodies required was reduced by eighty percent. Of course this was inevitable. As the number of people involved in using their hands reduced, the number of people sitting at keyboards increased, also inevitable.
    At the same time there was the inexorable rise of the number of businesses attaching themselves to the prime producers, the so called outsourcing revolution, again mainly fingers on keyboards, except the lawyers of course, fingers in wallets.
    It is no coincidence I suspect, that
    the rise in job dissatisfaction has it's roots here. Particularly within the Civil Service who in any case have an altogether alien work ethic.

    As for the nursing profession, as the son of a district nurse, I look at todays shenanigans open mouthed. The latest madcap scheme another example of an administration running out of control. Nurse Gladys Emmanuel MARCA.

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  2. A subject close to my Victor Meldrew side Nige. Spent most of my life organising the making of things, that most tactile of earners, manufacturing. In forty years this process became so dominated by computer control that the number of bodies required was reduced by eighty percent. Of course this was inevitable. As the number of people involved in using their hands reduced, the number of people sitting at keyboards increased, also inevitable.
    At the same time there was the inexorable rise of the number of businesses attaching themselves to the prime producers, the so called outsourcing revolution, again mainly fingers on keyboards, except the lawyers of course, fingers in wallets.
    It is no coincidence I suspect, that
    the rise in job dissatisfaction has it's roots here. Particularly within the Civil Service who in any case have an altogether alien work ethic.

    As for the nursing profession, as the son of a district nurse, I look at todays shenanigans open mouthed. The latest madcap scheme another example of an administration running out of control. Nurse Gladys Emmanuel MA.RCA.

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  3. Thought I would say it twice, for effect.

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  4. The author of this interesting book suggests a neurological explanation:

    Well, he world, wouldn't he, being a neurologist and all that? But malty nails it--twice in fact. It's about our slavery to the computer and the author may just be putting the horse before the cart. No doubt if the good professor were observing a forced labour camp, he might conclude that the part of our brian that favours physical over sedentary pursuits has evolved dramatically of late.

    I haven't a lot of recent experience with nurses, but you can see the moulding effect of high-tech on young brains in a lot of stores and restaurants. Recently I embarassed by son by getting mildly huffy with a young teen in a coffee/sandwich chain shop. The dialogue went something like this:

    Me: "I'll have a plain chicken salad sandwich on white to go, please."

    She (after being nearly defeated trying to find the right cash key): "Chhickkenn salladd...(Enter!) Would you like that toasted?"

    Me; "No, plain, on white, to go."

    She: "Plainne" (Enter!). White or brown?"

    Me: Uh, white, please. To go.

    She: "Whhitte" (Enter!). Here or to go?"

    So, I treated myself to a cranky mutter on the hopelessness of youth, which was totally unfair. She knew very well irritating a customer was far less serious than messing up the computer and she, quite wisely, had adjusted her little grey cells accordingly to meet its demands and conform to its rhythms. A mutation born of the survival imperative in the best Darwinian tradition.

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  5. Agree, nothing seems to get done any more, though people do seem to have time to make multiple errors when pushing computer keys. I spent last week tearing out my hair at the gross incompetence of British Telecom – the catalogue of crossed wires and the resulting mayhem is far too long and involved a story to recount here … I’m sure the very mention of BT is enough for you to understand exactly what I mean. I have a hunch that the company is run from Mr BT’s living room, with the assistance of a virtual PA in Scotland and a call centre in the Philippines.

    The answer to getting things done seems to be ‘do it yourself’. In this mad, multi-tasking world, each of us is expected to be a unit of individual responsibility. We barely have time to look after ourselves, let alone others, when we’re stuck on the phone to BT for half the day, whilst our call is passed via 15 different operators in an attempt to resolve why one of our lines has curiously been registered in the name of Mr Kanapathippillai Manogara of Plymouth Food and Win (sic). Anyway, after 8 weeks negotiating with various call centre operatives over their multitude of failures, fingers crossed I have sorted the problem, leaving me free to attend to the 60,000 spam emails I received one otherwise carefree afternoon.

    Perhaps we should issue the ill and infirm with computers to find themselves decent nurses, seek out cures for their ailments and learn how to perform complex surgical operations? Or maybe someone should actually get down to work and start sorting out this crazy mess we’ve got ourselves into…

    Left-handers taking over the world - sounds like the evil plot from an Austin Powers film. By the way, can anyone mend a leaking roof?

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  6. I too am left handed, although I have never considered a career in nursing

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  7. The cure is simple. But it involves machine-guns.

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  8. Can't fix a roof Susan - too busy responding to emails. But I know a man who can fix a roof and can do virtually anything else, with a simple set of tools. His name is Alin, and he is from Romania. While working he eats nothing, breaking from his toil to, briefly, drink black tea with two and a half sugars. He uses no dust sheets as he makes no mess. Yesterday I asked him when he would be back. He said 'I come back Monday, ten to eleven'. At 10.50 tomorrow he will be here. I don't know whether, in Romania, everybody has a computer. Somehow, I doubt it.

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  9. Susan, there is a firm of roofers in Newcastle, not sure about their credentials though, on the side of the van 'Milan : Paris : New York : Buenos Aires : Wallsend'
    I wonder if they are cowboys?

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  10. Nige, I did a bit of this left-brain/right-brain stuff on the course I attended last week. I suspect you're correct, that us lefties are possibly right-brain dominated - we're generally perceived to be more creative types, and I have certainly encountered a disproportionate number of left-handers in 'creative' jobs. However, to look at it another way, I actually feel that in the modern education system there is too much emphasis on the right brain, touchy-feely stuff, to the detriment to the actual learning of facts (more of a left-brain thing).

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  11. It's a cliché but the nurses during my recent hospital stays were wonderful, if busy. They didn't seem to be over-encumbered with computer work, just work in general. But I nevertheless felt I received sufficient 'quality time'.

    I couldn't agree more with you about the proliferation of graduates. We're lining up a huge number of young people up for one hell of a fall. Study, debt, expectations, job behind till. I suspect we could have quite an angry and resentful political culture in the next few years.

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  12. The book "A Good Day in Hell. The Flatlining of Nurses Across America" describes this problem in detail. The promotion in Nursing is away from the bedside and those who are faced with the harsh realities of trying to take care for their patients are weary, wornout and frustrated.

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  13. "Sorry, Florence. No degree, no job: The Government's latest proposals to improve care for patients will have the opposite effect – and leave nurses worse off, says Theodore Dalrymple."

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  19. i am a left handed nurse. have been for 20 years. i can only speak for myself because it would seem i am a right brained person and i have no interest in looking for any statistics. i find it very difficult to be in the environment that i work in. my strength is how well i care for my patients as people. communicating with them, making sure they are comfortable while they wait for their evaluations to be completed (i work in an ER). but the system is hung up on statistics, getting all the details right etc etc etc. not that it's not important to get the details right, but there is no reward for providing good bedside care. managers don't look for that. i work with a number of nurses who have gone on to get their masters, most of whom are still working the ER rather than using these degrees. i'm glad i will be grandfathered in and not forced to go back to school. i have absolutely no interest in more nursing school, more papers, more stats classes, more instructors looming over your shoulder looking for you to do something wrong. i would rather be tarred and feathered and dragged down a gravel road. i'm studying photography now, and by the grace of god this will save my heart and soul. because nursing has never really been the right place for me.

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