Cruelty toward patients is not a normal occurence. Reflecting on my many years of nursing, I would estimate that 10% of nurses and nursing assistants were capable of varying degrees of cruelty, whilst the vast majority were compassionate; differences that reflected underlying personalities.
It was evident that a small minority entered nursing to bully and humiliate patients, as they had been bullied and humiliated in childhood. Another (larger) minority viewed nursing as nothing more than a job, the stress of which they resented, ‘taking this out’ on patients by being indifferent, and sometimes hostile.
The great majority of nurses I knew were generally kind and compassionate, and tried their best to rise above the stresses of their personal lives, and the stresses of being short-staffed, to not ‘take it out’ on patients. I imagine this is the case now; the proportion of compassionate nurses reflects that of the compassionate in society.
The paramount qualification for entering nursing should be a compassionate attitude. The focus in recent years has been to promote nursing as a degree profession, with a concurrent increase in the number of lecturers, who, naturally, promote this concept, but might also suggest that the value of education in a world of rapid technological change is important in nursing, a most valid point.
The question becomes one of what education? That has already been answered. Whatever the name of the UK government, their focus will be on cost reduction, and they will follow the lead of California, which trains an ever-growing number of ‘nursing technicians’, trained by private colleges, to perform roles once exclusive to nurses. These ‘technicians’ (of less wage cost) receive highly focused training in specific areas of nursing, over a significantly shorter period than the three year nursing degree, which gives specific training in a number of areas, with the graduate then abandoning the ones not needed to persue their speciality – a waste, as increasingly seen by government. It can be added, the training of nursing assistants and technicians in California stresses the importance of a compassionate attitude.
Saying that recently qualified nurses persue a speciality is not to infer that the majority of them get jobs in nursing – they do not – a survey of online hospital job sites shows that the majority of hospitals require ‘six months experience in ….’, which new graduates have not got; the practical training they received in their degree not being enough to convince hospital managers that they can ‘hit the ground running’. The number of jobs available for new graduates varies, of course, with hospitals in rural areas, which find it difficult to attract staff, offering more jobs than cosmopolitan ones.
Not all nursing graduates are careerists, who want to become lecturers or managers: I worked with many ‘graduate’ trainees, and I would have been delighted to have been their patient, as much as I would have dreaded to be under the care of some not so tender nurses I knew of yesteryear, some of whom were not particularly compassionate or competent; hence their career move into lecturing.
It is untrue to suggest that nurses of yesteryear where not ‘educated’ – I worked with many who dilligently followed the latest nursing research; who could sit in the hospital social club after work and discuss Plato and Shakespear; this latter attribute applying to the same proportion of nurses in any generation, and to care assistants, some of whom I have appreciated as among the most intelligent people of my acquaintance.
We are divided so as to be ruled; everything good in nursing, just as everything bad, is not the preserve of any one generation. Respect each other where due, admonish each other where due, but never demonise on a generational basis, and be the puppets of the Murdoch press.
A point is, we place too much emphasis on academic work. Nursing students on ward placements have to complete assignments, on top of having to juggle with the demands of family. There is an undue stress put on them, and for what purpose? Do assignments make for better nurses, or do they serve the interest of the nurse education industry, the members of which are well represented in the RCN, which has traditionally supported nursing as an all degree profession. Whether the RCN will continue with this stance in the face of the overwhelming economic tide that continues to sweep their way is open to question. The important thing for any union is membership, whether that member is called a graduate or a technician. I am not saying that some nurses should not have degrees, but a fewer number, and they should be guaranteed top level jobs, once having demonstrated a high standard of compassionate care in a hands on capacity for at least three years.
As much as cruelty toward patients is not a normal occurence, it should not be denied to exist. We should not be satisfied with it being perpetrated by a small minority, or it taking place in areas that we have never worked; saying: “I have never seen it, therefore it does not exist”. Cruelty has always existed in nursing. As a young nurse, I read Mr Mitford’s work of 1825, which exposed the cruelties to be found in ‘Mr Warburton’s Mad-House’. This tract is important reading, I suggest, for all nurses, in that it gives a face to cruelty within the context of its time, which saw children as young as nine being hanged for petty theft; a fact that does not feature in the school history curriculum. I do not suggest that the instances of cruelty reported by Mr. Mitford are repeated on the same level today, rather, that the same callous attitude that underlines all cruel behaviour is common to all eras.
In the following excerpts, I have replaced Mr. Mitford’s full naming of the recipients of cuelty, which he gave with details of their family connections.
‘If there is in the breasts of men one sacred spark of love, humanity, or pity, it will be called forth for helpless beings, lashed and tortured by fellows deserving of a gibbet; and where, both by men and women, deeds are done that shun the face of day, and enormities practised that cry aloud to heaven for vengeance’.
‘And on a careful exposure of this diabolical establishment, I doubt not all will agree with me in opinion, that these ” lawless houses under the law” should be done away with entirely, as a disgrace to human nature. The angel of death moves through them ‘with secret and murderous strides; like Doctor Sangrado’s patients, in “Gil Bias,” all that die are wrote down — cured’!
‘The visiting physicians are not to blame if they make good reports of Hoxton mad-house, as they are deceived. A week or two before their visitation, the patients are better fed, and more kindly used, Tommy himself sometimes dines with them in the parlour, in order that he may say —” Oh, the patients live so well I frequently dine at their table from choice!” The house is moreover cleaned, and new clothes distributed to those in rags; so that, to outward appearances, the physicians are satisfied. If any poor wretch (confined and in his senses) dare complain, a score of keeper and keeperesses, that is, rogues and prostitutes, are ready to testify that it is only a ” lucid interval.” If the poor fellow becomes enraged at these falsehoods, as it is natural he should be, it immediately is set down as a proof of the truth of the keeper’s assertion’!
W.C.A. ‘This truly unfortunate gentleman was an inmate of Whitmore House; and his place of abode, the back parlour: he was, undoubtedly out of his senses; his was “A night which knew of no returning dawn;” he would stretch his neck out of the window, and address the Speaker of the House of Commons in the language of a lunatic; and he has been beaten from that window by a weapon wielded in the hand of a brute — for such was his keeper. I qualify no crimes; I withhold no man’s name from censure or praise; William Wootten, one of Warburton’s most confidential scoundrels, was he that daily and nightly tormented Mr. Alcock with blows, and all the arts that a villain can conjure up to render the unhappy more miserable’.
Miss R. ‘This amiable and interesting girl had been some time in the Asylum before I knew her; her parents were (I understood) very anxious about her recovery, and she had at intervals dawnings of reason; at these times she was admitted into the parlour, and conducted herself in such a becoming way that I am fully convinced kind treatment would have restored her to her afflicted parents compos mentis …. Chance had thrown into Warburton’s establishment a fellow named Kelly; he was a young man, and by the contrivance of Mrs. Bruning, the keeperess of the gaol, he slept in the same bed with Miss R. many Saturday nights. I have seen them in bed together, not once, but twenty times. Behold, reader, a tale worthy of thy execration — I have seen the person of that child, for so I must call one bereft of reason, prostituted on the steps leading to the lodge, by more than one keeper. I have heard it mentioned to Warburton, and his answer has been, ‘it is no matter; she don’t know what is done to her’. I could not, at that time, take upon me to knock the villain down who used such language, revolting to human nature; but, thank Heaven, I live to record his infamy, and make the world abhor him’.
‘There is a widow of a captain of marines, whose name I have forgotten: I believe she was put into Whitmore House for getting intoxicated and abusing her neighbours, but she is no more insane than the reader. In fact, insanity is not required to gain a place in Warburton’s den; he receives any one; whether fraud, malice, or self-interest prompt the relatives, it is to him a matter of no concern, and he has art to procure a physician’s certificate whenever he pleases. This lady of course was strenuous in her endeavours to escape from confinement, she wrote a letter to a friend, which the keeperess found in her possession, and as a gentle admonition for her presumption, she was well flogged with a rope, and tied to her bed-post for a week, not permitting her to retire for the purposes of nature, and the stench in the room was abominable. Another attempt made by her some months after, was followed by confinement in the cellar; there she was strapped down on a tester bed, which stood betwixt two necessaries, used by all the house … and which were only emptied once a quarter; the floor was paved, and so wet that the writer, who explored the place from curiosity, in some places got wet over his shoes; the vaulted roof was never swept, but hung with cob-webs, nor was there any light but what a small lamp afforded, which was occasionally lit at night; here a tender and delicate female was confined, and opposite to her, chained down in a similar way, was a being raving mad, whose howlings; execrations, and blasphemies continually sounded in her ears; but the hardened hearts of the keepers only laughed at this wretched woman’s sufferings, and frequently left her without food for two days together, and then served her with tainted meat, and sour small beer — a slow poison, which in that house, has carried many to the grave’.
‘The patients have tea in the morning, and a small slice of bread and cheese in the evening. In the front parlour are those whose friends can afford to pay most liberally; but it is a common custom to put those who are so bad as not to be likely to complain, and for whom Warburton receives the first price, into the hall, and when they are visited by their friends, they are decently apparelled, and brought into the front parlour, where their friends imagine they always reside. Wine is invariably charged to all the parlour patients, but scarcely one gets a glass except on a Sunday. In the back parlour, which is the second degree, a pint of porter is allowed to each man. This wretched beverage is made worse by the keepers, who mix it with water and stale small beer, and reserve for themselves sufficient to get drunk with every night, which is their common practice when the patients are put to bed. If the patients’ friends leave them any money, the keeper takes it away the instant they are gone — and those who have weekly sums are obliged to share it with their task-master’.
‘There was, and may be now, for aught 1 know to the contrary, a Mr. C. confined; he was not mad — if he was, there was more ‘method in his madness’ than I have ever seen in any one even suspected of being non compos mentis; in truth, Mr. Church was a man of fortune; he had made the grand tour, and brought home all the foreign vices that degrade most of our continental travellers: he was in the habit of committing a foul offence for which the law assigns the punishment of death, and would have been very justly hanged; but Mr. Warburton’s house received him as a lunatic, and saved his neck. He took advantage of a lunatic, the son of a colonel in the army, and repeatedly committed the same crime with him, in a room at the end of the house, facing the garden, occupied by a patient named H.; no pains were taken to prevent this horrid intercourse; Mr. C. had money, which he distributed amongst the keepers, and his enormities were only talked of as tilings of course; yet that man sat in the front parlour, at table with men in their senses, and women too, quite capable of judging, and shuddering in the presence of such a monster. But morality never entered the head of Tommy Warburton, or any of his myrmidons. A poor wretched young girl, who was decidedly insane, and whose name I do not choose, to mention, was got with child in this brothel, and the keepers I used to taunt each other with being the father’.
‘The servants in this house are men of the vilest description: if they are stout able-bodied men, no question is asked where they lived, or how they lived — and the women are hired on the same terms. One keeper, Kelly, was a deserter from the army; another had served fourteen years at Botany Bay; another was a known thief at the police offices; and seven of the keeperesses were acknowledged common strumpets, and slept with the keepers or sane patients every night, and this was sanctioned by the housekeeper, old Mother Bruning’.
‘Mrs. W. The authoress of many good books for little children, is frequently an inmate of Whitmore House; when she recovers, and the paroxysm goes off, she returns to society, but when she is ill they (the keepers) rob her of all she possesses. I remember — can I ever forget it? — when they stripped her in the cellar of all her apparel, which was new, and sent her up naked, all but her shift, into the parlour, pretending she had thrown them down the necessary; a new dress was ordered, and the keeperesses divided her garments amongst them … this brutal mode of robbery is frequently resorted to by those demons, and whenever a friend or relative is expected, they often dress the patient in rags, in order to have more clothes ordered’.
‘There is no separation betwixt the women’s rooms and the men’s but the broken doors, they lead into the same gallery, and the patients have access to each other whenever they please. Poor Miss R., one morning was found in the room of Mr. Daniels, a gentleman called to the bar, but unfortunately deranged. The keeperess, who had not sanctioned this visit, dragged her out by the hair of her head, beat her head repeatedly against the wall, and then tying her legs, flogged her as children are flogged at school, in the presence of half-a-dozen monsters in the shape of men, whose remarks at the time are too indelicate — too shocking for repetition’.
‘This mode of punishment was often put in practice, and when the sufferer was too strong, and resisted, a male was called in to assist at the revolting operation. Mr. Jemmy Davis was peculiarly active on such occasions, and seemed to take a pleasure in tormenting; he gloried in his inhumanity, with which Mother Bruning was so well acquainted, that whenever any of the patients were inclined to be obstroperlous, she threatened to send Davis, and the horror of his name instantly made them quiet’.
‘My remarks are straight forward; it is true, I cannot back them with all the influence and power which wealth gives to individuals in the present times, but they are backed by unanswerable truth. Mr. Warburton may be silent, if he pleases; no one will interpret his silence to conscious innocence; but to “stand mute,” and not by the visitation of God, is the way many public men now support their character’.
‘Mr. V. A young man, the son of a flour merchant at Greenwich, and who had been a clerk in the East India House, had recurrences of his senses, which lasted for a day together, and during which time, the keeper was endeavouring to drive him again into a state of insensibility, by repeating to him the actions he committed when in his raving moments, and irritating his feelings in the most inhuman way. He has repeatedly said to the writer: “They will not let me be at peace, and 1 too sensibly feel I shall experience a relapse without the aid of their cruelty to hasten it.” From no cause whatever have I seen this youth, when compos mentis, dragged off and fastened to this bed of torture, and kept there for two days on bread and small beer. There is an aperture in the middle of the bed, and some flocks under the shoulders of the poor wretch, but no covering whatever; the windowfctis broken, and the rain beats in upon the bedstead freely’.
‘Opposite the door of this den … are the two privies, from which arises a most intolerable smell, as there are no sewers to carry off the soil, which is suffered to accumulate till it reaches near the top, and they are full seven feet deep; I remember when they had not been emptied for six months. These places are on the left hand after you have descended the steps, and at mid-day, you must have a candle to find them out — which you cannot do by the smell, as that pervades every part of this dungeon, and every gasp of breath draws in pestilence and pollution. Betwixt those receptacles is a small room, in which a wretched old man was constantly confined. 1 have been assured that he was seven years there without seeing the light of the sun’.
‘I am induced to give one more case of a female, and shall particularise no other. This lady had been a dweller in darkness for some years, and was apparently about twenty-five or twenty-six years old; she was a harmless lunatic, dressing herself up with flowers, carrying a basket of them, and chanting simple songs, at intervals, as she repeatedly paced the galleries or the garden; they called her “Crazy Jane,” and that was the only name I ever knew her by; she was very pretty, but with all that wildness of appearance about her, which Shakspeare has given to Cassandra, the inspired denouncer of the fate of Troy … This poor maniac — this Crazy Jane, had sufficient beauty to attract the eyes of the keepers, and was made the victim of their lust; and 1 have often seeu her hurried by them down into the cellar, before I knew the horrid purposes for which it was done. That she had some feeling I know—but whether bodily or mental sufferings brought it forth I am ignorant, though in either case it is dreadful to think of; for I have seen her hurry tottering up the cellar steps, from that cavern of pollution, her eyes streaming with tears, which she tried to hide as she ran into the garden. And at such times 1 have seen her beaten, the keeperess declaring ‘she could not keep her from the men’— a burning lie to my certain knowledge; depraved in themselves, they knew not what virtue meant, and the sacred stream of pity never flowed in their corrupt veins. Mr. Chawner, the clergyman, once emphatically denounced those women to the housekeeper as ‘the sweepings of Hell,’ if so, it is a pity that place should ever be swept; at all events, they are the scum of the earth, and were the kennels of St. Giles’s to be raked for infamy, none would be found to equal them; yet they dressed well, and could assume a look of cheerful humility, and shew tenderness to their patients when occasion called for them thus to do penance to the real sentiments of their base hearts. I have seen them receive presents from the afflicted friends for their kindness, when those, from whom they received this reward, were worse used by them than any others’.
‘If 1 have given any one feeling bosom pain, in the course of this little narrative, I am sorry for it, having studied to mention families or names no more than was absolutely necessary to give effect to this exposure of the Horrors of a Private Mad-house, and rouse an abler advocate to reform them. If I succeed, by this attempt, in removing a chain from the leg of one sufferer — of suspending the lash, wielded in vengeance over the innocent head of one poor victim — of preventing the violation and degrading treatment of one unfortunate female, I shall think myself happy, and under the self-approbation of my conscience, defy the threats of a wealthy petty tyrant and merciless oppressor’.
Mr. Mitford, it should be said, was a brave man. Anyone who questioned the norms sanctioned by the depraved ruling class (the condoners of hanging nine year old children for petty theft) were subject to intimidation and ridicule. As said, the degree of cruelty discovered today is less than that reported by Mr Mitford, but the underlying disrespect for a fellow human being is a common feature of all cruelty.
Some recent press headlines:
‘A dog in a vet’s would have received more caring and humane treatment than I did that night’ … ‘announced the arrests of six nursing home employees who physically abused elderly residents by coating them in an ointment cream to play a cruel and shocking prank against their co-workers’ … ‘Five nurses were today found guilty of neglect at a care home where malnourished pensioners lived on porridge and had pressure sores so deep that their bones were exposed’ …’Police have launched a fresh probe into the allegations after a top-level dossier claimed health workers hit, threatened and humiliated patients, withheld food and drink, locked them in cupboards and drove them to well-known sex spots for their amusement’ … ‘Cruel carers mocked, bullied and assaulted elderly residents … for laughs’ … ‘Three cruel care workers have been found guilty of ill-treating elderly ‘ … ‘Cruel members of staff caught horrifically abusing vulnerable residents at a care home were jailed today’ … ‘a culture of cruelty at the care home’ … ’11 care home workers sentenced for shocking abuse’ … ‘the victim of neglectful, demeaning, painful and sometimes downright cruel nursing’ … ‘A nurse subjected frail pensioners to psychological abuse’ … ‘woman with dementia repeatedly punched and slapped’ … ‘a disgrace to her profession’ … ‘behind bars after subjecting vulnerable dementia sufferers to shocking abuse’.
I am not a political supporter of the present and past government, who, in their various ways have contrived to make the NHS attractive to big business interests. However, when any government plans to make it a requisite for those entering nursing to undertake twelve months of working as a care assistant, during which their attitudes can be scrutinised, then, on behalf of patients, I support it. I do not oppose it on the basis of ‘protecting nursing’ – there is a sickening emphasis on what is assumed to be good for nursing, and claims that this is synonomous with what is good for patients. Whatever is good for patients is good for nursing, and if that includes being cared for by more care assistants and nurse technicians with compassionate attitudes, then so be it. In like manner, protecting ‘nursing’ is not synonomous with protecting the NHS; although the vested interests attached to nursing would have you think it is.
I would also emphasise that the area of greatest concern regarding cruelty to patients is within the private care home sector, as evidenced by the constant stream of court cases and NMC hearings. I strongly suggest that it becomes compulsory for such facilities to install cameras and microphones in every area of their building, including patients’ rooms, and that all patients’ outings should be similarly recorded. To paraphrase Mr. Mitton, if this suspends the lash, wielded in vengeance over the head of one poor victim, then it would be worth it. Objections on grounds of invasion of privacy would be made by those who are not victims of cruel behaviour, with it probably being the case that they would change their stance if they were. And, let me be plain, the terminus for all those who become ill is the private nursing home, the hospital ward is only a stop before that, and any that think they will never become ill, or that private medical insurance will ensure them better care, are naive in the extreme. Nursing homes (mostly owned by private equity groups) are the stables that need to be swept clean, in my experience, yet in whose interest is it to do so? Business friendly governments are not likely to impose costs on businesses that fund their particular political party.
c. lenin nightingale 2014