Over the past few years, nurses and midwives in the UK have been reminded of the “6 Cs” of nursing care. I first heard my friend Joanne Bosanquet (MBE, Queen’s Nurse, Deputy Chief Nurse, Public Health England) promote the model. On the one hand, it’s great – especially for those new to the profession, to have this model outlined and explained to them. On the other hand, it seems a shame that any healthcare professional should need these 6 Cs clarified or spelled out! Surely these 6 Cs ought to be running through the veins of every caring professional? Without the 6 Cs, encircling genuine compassionate care, then our professions means nothing!
The 6 Cs of nursing care, as defined by Chief Nursing Officer for England Jane Cummings, in 2012, are: care, compassion, courage, communication, commitment and competence. After spending 5 years as a student nurse (orthopædics then SRN), followed by 10 years with the Catholic Church, I then returned to nursing to work as a staff nurse (on a ‘d’ grade salary, a current band 5, as I had been out of nursing for so long) on an HIV ward at St Mary’s Paddington, as I have already explained on another page here.
The year was 1989; the word “AIDS” was only 8 years old, and the virus, HIV, only labelled as such in 1985. HIV started off being discovered by the French in 1983, and called LAV (Lymphadenopathy Associated Virus), then soon after hijacked by the Americans and re-named HTLV-III (Human T-cell Lymphotropic Virus – type III) before the WHO intervened and renamed both labels as HIV. These were frightening times for everyone. Of course most frightened were the people living with this new condition. Also terrified were their loved ones, and other people too frightened to be tested. But many healthcare professionals were frightened too, some so much so that the stories of the abysmal ‘care’ they failed to offer is an indictment against the whole notion of ‘caring’ or ‘professional’. The fears were whipped up in to a frenzy and moral panic, with the worst forms of stigma especially doled out by elements of the (hypocritical) media and press.
There are a couple of stories I want to tell you of those days, so that we never forget them.
I’ve tried telling them in lecture halls with up to a couple of hundred nurses and midwives present, but I always get too choked up to continue. So I’ll tell one story here, Damian’s story (names totally made up, of course, for sake of confidentiality). Another story, that of Matthias, Matt, I’ll tell you on another page.
I don’t mean these stories as in any way to ‘show off’ the care I felt I was destined and educated to provide, or as a criticism of others. They are just as they are!
Damian’s story and the 6 Cs
Damian was on one of the first drugs to be licenced against this new infection called HIV. He was on zidovudine, or AZT. Many people grasped at straws back in the 1980s and ‘90s, wanting to be on anything that offered even the slightest bit of hope at all. Damian required monthly blood transfusions as a result of the toxic side effects of his anti-HIV medication. He and I had a fantastic rapport from day one. We had such a banter between us, that it was always great to see him, although I wish to this day: not in those circumstances. Not long before he died, he was admitted for one of his transfusion stop-overs. I was working nights; in the middle of my shift his room buzzer went off.
As soon as I entered Damian’s room I could see he was totally drenched from a ‘night sweat’. They were totally disabling for so many people who experienced them. Not only would the person have nasty rigors (extremes of temperatures, at once going right up high, making them feel boiling hot, then down to freezing cold, shivering and chattering of teeth), but the excessive amount of sweat pouring out of them would look like someone had thrown a bucket of water all over the bed!
As soon as Damian saw me, he said how sad and dreadful he felt at yet another night wet; he apologised, too – not that he needed to, of course – for the fact of needing help. I started chatting to him, both to reassure him and boost his spirits. As we were chatting, I just slipped over to the sink unit in his room and filled a bowl with warm water. I picked up his sponge and some clean towels, then made my way back to his bed side.
Damian was really tall, but had lost so much weight because of HIV wasting disease, that he was quite a light weight – just as so many of them were back then. So, we just kept chatting, so-much-so that he barely noticed me sponge him down and dry him off, head to toe, all over his body. As I did so, I would keep him covered up, only exposing the parts to be washed; this was not just for his personal dignity and privacy but to keep him warm: he was shivering by now.
We kept on chatting, taking his mind off the situation, as I got on with the task of washing him thoroughly and drying him, making him far more comfortable than he had been earlier. He knew this viral infection (HIV) was now starting to get the better of him, and he freely talked of his worries and fear about the future he was facing and exactly how he would face it. They were harrowing times and conversations.
With dogged determination – he was so light, it wasn’t a problem for me anyway – once I finished sponging him down I also changed him into new clean pyjamas. We kept on chatting. Not only did that make the time fly by, but it took his mind off me rolling him around, from one side of the bed to the other, as I managed to change the bottom sheet from under him (and wipe his sweat off those dreadful plastic-covered mattresses), and give him a new top-sheet and blankets. Finishing off by going to make him a drink, it was great to see how much more relaxed and comfortable he was now.
I did all of the above for Damian without thinking about it. It was the “natural” thing to do, call it nursing – or more like ‘human’ – instinct, almost auto-pilot reactions. He didn’t need to ask me to do it; I didn’t need to consider whether or not to do it: I just did it! As I left his room he said to me “Thanks, Dave, for doing that. No one’s done it before, they’re usually busy so they just chuck me a pair of pyjamas to change into, but I don’t bother if I’m feeling too weak”.
I stepped outside his room and I cried!
Click the links for my related stories of HIV client care, at St Mary’s Paddington: