The issue of nursing or care, extends way beyond the patients bedside. Why have poor reports of care not hit the main news headlines for many years? Why do we never seem to read the truth? Consider Hillsborough, or Saville, or unemployment and immigration levels. The press are restricted by politics , and likely to be ever more so- as are certain search engines.

There are even restrictions on books that are read- if any. History is already restricted, and has been for many years.  For the moment, look to alternative news sites eg 4bitnews, RINF, Raw Story, Before it’s news–

No, not second rate, just excluded.

Culture and Care

Culture and Care

Culture  may define to some degree how  a person behaves and the attitudes that they have (Durkheim). For example, nurses from some countries may display  a more positive attitude towards older people than from other countries. This may be demonstrated in such aspects as respect or dignity. There are NMC cases which involved such as calling an old person names; is it possible that cultural factors influenced  the nurse ? This is not to excuse the behaviour, but to heighten awareness of factors involved so as to address the situation.

There is  a high use of overseas nurses within all fields in the UK, but especially within the private sector. Duell (in Dimon 2013), discusses that many nurses from overseas complain less. Of course, this may depend on which country they are from. Many countries, discourage the questioning of doctors or more senior staff. How then can we expect such staff to immediately adapt to the UK? There are also differences regarding such aspects as pain control (RCN 2003). Of course,  countries may lack the resources and methods that other countries have. Indeed, some people are still expected to have a stiff upper lip and carry on despite pain. This article will explore the difficulties that nurses from other countries may face when adapting to work within the UK.

Culture may be influenced   within one country by such factors as   affluent areas and   poor areas . There are also cultural  differences between countries. Obvious differences include religion or tradition . There are present UK campaigns against female genital mutilation  within some parts of Africa for example ( .

It is indicated that the wealthy have less empathy, which may be hastened by the work ethic- you earn what you get, and their aim to justify their wealthy position (Goleman 2013).

Physical restraint of individuals is used in some other countries to a greater degree than the UK. For example, in some regions of South Africa, there is no community care, so  a mentally ill person may be chained to the wall while the relatives have to go to work to earn money to eat. In Somalia, mentally ill patients may be put in a cage with hyenas (Hooper 2013). Therefore, nurses from such countries may well regard restraint as the norm.

Culture also affects expectations of care. Some patients may well accept  queuing for a bath with other patients . Some individuals in some countries, as in parts of Africa, still believe in witch doctors and that evil spirits cause  mental and physical ill-health.

An analysis of NMC cases indicates  that some nurses who are convicted at professional conduct hearings may well be from overseas. However, the NMC does not keep  a record of overseas status, unlike the GMC. Such a record would help to monitor the situation. Indeed, nurses from different regions within Africa have been known to refuse to work with or communicate with one another, due to tribal differences.

Finding actual cases of poor care of patients in the UK which may be determined by culture is not easy. There are some newspaper reports that  state  the nurse was from overseas, there are also cases that involve UK trained nurses who abuse patients.

The following does refer to nursing in  Nigeria, but again it may not refer to all nurses;

“Picture this scenario:  a nurse is beating a sick patient in bed. Reason : Madam Nurse was provoked by the patient’s groans. A deadlier scenario:   a weak but desperate asthmatic patient is in a struggle with a nurse who wants to strangulate him. This triggers an attack and the patient frantically reaches for his inhaler, only for the nurse to smash that life instrument on the ground, breaking but not totally destroying it, before the patient manages to get it out of sheer willpower. This may seem stronger than fiction, but these two events happened only recently. Welcome to the deadly world of Nigerian nursing” (Kowale 2012).

The author questions why, despite the Nigerian Code stating “the nurse must provide care in such a manner as to maintain the integrity of the profession”, such attitudes prevail. Such an example as this indicates that there are people of conscience within all countries.

Simulsesli (2012) further analyses the work of Jewkes et al 1998, asking why abuse of midwifery patients occurs in Zambia. He concludes there are many underlying sociological factors, but they can be challenged by, for example, positive role models, effective complaints procedures, and improved working conditions.

I argue also, there are political factors which fuel the work ethic belief that some people are more deserving than others, because they work.

Indeed, such attitudes prevailed within the UK, and other Western countries, many years ago, as evidenced within workhouse records or by such authors as Barbara Robb. Pregnant mothers were still hit by midwives, until the 1970s in London, according to Jewkes et al 1998. Is it possible that within the UK, and other Western countries, there is  a return to this era, with such examples as patients in some hospitals and care homes  being tormented and ridiculed.

Of course, I am not saying do not employ staff from overseas from different  cultures. There are some excellent staff from overseas . What I am suggesting is that they should be  better prepared by a more robust adaptation programme for example,  a cultural adaptation course. We consider cultural differences of patients- so why not staff?


Dimon C (2013) The Commodity of Care Cloister House Press

Free updates

Durkheim E Ethics and the Sociology of Morals Prometheus books

Goleman D (2013) New York Times Rich People Just Care Less October 5

Hooper R (2013) Where Hyenas are Used to Treat Mental Illness 17 .10 bbcnews

Jewkes R, Abrahams N, Mvo V (1998) Why do Nurses Abuse Patients? Reflections From South African Obstetric Services  Soc Sci Med v47 n11 p1781-1795

Kolawole K (2012) Nigeria: Ethical Issues in Nursing Practice 6 December

RCN(2003) “We Need Respect”: Experiences of Internationally Recruited Nurses  In The UK 1st March

Sumulesli A (2012) Why do Zambian  Nurses Abuse Patients? Zambian 22 August


Carol Dimon c 2014



Quality Care Differences


Interesting- USA states results concerning the number of top rated nursing homes per state, not dependent on the number of homes.…/us-news-best-nursinghomes-2013-1

 Amongst the many factors, we may well have cultural implications such as number of overseas staff and patients within a state, number of people in poverty within a state, regulations within that state, education within that state, who owns the majority of nursing homes within that state. Such an analysis would indicate so much.
References indicate people who are less wealthy, are considered with less regard by some (work ethic), and attitudes and education,  do differ between cultures whether between countries or within a country.

Carry On Poor Care

We remain concerned about poor care being hidden behind an excuse of short staffing. Short staffing causes a different type of poor care eg omissions. It does not cause cruelty eg stuffing paper in a patients mouth and tying her to a chair, throwing a beanbag at patients, sitting on patients, sexual abuse, shouting at patients. Nor other types such as leaving patients in wet beds or errors. Yes some errors may well be increased with short staffing. Yes some patients may be longer in a wet bed with short staffing, but it is not the only reason. Such practices have existed for years and many refuse to speak of them.Yes- more likely in certain fields of care than others (do have refs) and yes, hard to acknowledge but, if we continue to hide it, we are as bad as the perpetrators themselves. Again a main factor is attitudes which may be determined by many factors.

Research or Not Research?

Some research conclusions-Depression may be due to loss, Short staffing contributes to poor care, Bullying reduces quality of life ,Poor care exists ,Working class children, have less chance of success, Overseas (nurses) English language is poor. I could go on. Point is- could it be  case of “I told you so? Whilst not disputing that some research is essential, has research become an industry, ? Research may be used to exclude the viewpoints of ordinary people. Indeed, agencies will only fund, what they want to fund.



Poor care IS poor care

Poor care in nursing- or any other care professions- in all establishments, has always existed (Dimon 2013) and will always be a potential problem that all staff need to know how to address. This is due to several factors including socio-political, neoliberalism, attitudes, low staffing and poor resources. Poor care exists on a continuum from unintentional to intentional. This is evidenced by blogs, research, NMC or coroner cases. Unintentional refers to errors such as drug errors, or well meaning staff who oppose the rights of the patient for outcomes determined by the professional. Intentional includes such as physical abuse- slapping, or verbal-swearing. The occurrence of this does vary between types of care. For example in specialist units such as ICU, there may be clinical errors rather than such as, leaving patients in wet beds or shouting at them. Reasons for this may be various, such as the higher attention paid to ICU patients, rather than continuing care of vulnerable patients including old people or mentally ill. There are of course, higher staff levels on specialist units with more qualified staff. Of course such units may face short staffing, if people are sick for example, but they are usually given the priority when moving staff from other units.
This is all regardless of who owns the establishments. However, there is evidence of deliberate shorter staff levels within private equity owned care homes (Fernandez 2012) . Indeed there is also a higher use of overseas staff within the private sector who are cheaper and complain less (Duell in Dimon 2013)
The training of overseas staff when arriving in the UK, is another factor. Indications are that it is inadequate (Dimon 2013) and cultural attitudes do of course differ (Jewkes et al 1996). Whilst this is an early reference, few authors write about this issue but it is supported by several blogs. There are a few articles highlighting further attitude differences, such as (RCN ) attitudes to pain relief between cultures (2003 in Dimon 2013) . Also attitudes towards older people , or restraint are addressed within other articles.
Mee (2013) discusses well, the issue that nurses need to take responsibility for their own actions , describing the situation of two adjacent wards, being very different regarding quality of care. This situation has been described to the authors, by several care assistants, who also are aware of possible reasons why. He also discusses attitudes of staff, and the willingness, or ability to oppose authority. Mee begins to do what is required- an analysis of the actual major incidents and why they occurred- not a whitewash of short staffing.
The excuse of “short staffing” is used as a smoke screen for poor care; primarily triggered by the RCN who aim to maintain nurse and HCA members, and avoid upsetting the profession. “We must only write about good care” they declare.
Of course we cannot dispute in anyway, that low staffing (which may occur unplanned), DOES cause poor care by for example, omitted aspects of care such as baths. It does not excuse however, swearing at a dying patient who was incontinent in bed (just one reported case). Nor does it excuse locking patients in a care home, in a “dungeon” (Gregory 2013).
There are so many factors involved. We really need to look at the issue of why we fail to accept that poor care in essence, does occur, even without short staffing. This tells us a lot about the issue. Is it fear of admitting? Loss of professional reputation? Loss of business? Guilt? Or is it the difficulty of the aspects- that so differs between cultures regarding expectations and acceptance? This has vast implications if people will address it- far wider than the issue of care or the NHS hospital ward. Indeed, unless there is a research reference for the existence of poor care, despite blogs and complaints, many fail to accept it.
This is a plea to focus upon “poor care” as the issue- and not “low staffing”.
Lenin Nightingale. Carol Dimon

Dimon C (2013) The commodity of care Cloister House Press

Fernandez E (2012) Low staffing and poor Quality of Care at Nations For Profit Nursing Homes UCSF Nov 29
Gregory A (2013) 7 workers ‘arrested’ after dungeon found in care home. 23.10
Jewkes R, Abrahams N, Mvo Z (1998) Why do nurses abuse patients? Soc Sci and Med v47n11 p1781-1795
Mee S (2013) Is workplace culture an excuse for poor care? Nursing Times 109;14-16 5 April