Understanding and Supporting Professional Carers

Janet Thomas

• Editorial: Routledge
• Año: 2021
• ISBN:
  9781315344911
• Edición: 1
• Categoría: Medizin
• Categoría: Medizinische Theorie, Praxis & Referenz

The National Service Framework for mental health aims to provide uniformly good systems so that mental health problems are detected and therefore treated early. This book sets out how learning more about mental health and reviewing current practice can be incorporated into a personal development plan or practice learning plan. It shows how to integrate quality improvements into everyday work and bridges the gap between theory and practice. Doctors nurses and practice managers can build up a personal development plan or a practice professional development plan through completing the exercises at the end of each chapter and it demonstrates how to include clinical governance in the mental healthcare services they offer.

Chapter 1

The relationship between personality and career choice

Introduction

The provision of staff support and counselling services for those who work in health and social care has evolved from recognition that these are stressful jobs. The personal factors in work-related stress in health and social care will be explored in this chapter, while Chapters 2 and 3 explore the contribution of organisational issues to the stress equation.

Many people have a vocation to do this challenging work. Often they know why they have made their choice, but sometimes there are hidden incentives. This chapter examines some of the possible conscious and unconscious reasons why doctors, nurses, social workers, counsellors and allied professionals join the caring professions.

The conscious reasons include practical considerations such as training, income and widespread availability of work. Family tradition has a strong influence on career choice, but not only in the caring professions. Some see caring as a worthwhile and satisfying job that helps to make a difference to people’s lives. Others gain a sense of belonging or importance from being part of a respected profession with a strong, sometimes uniformed, identity. Social workers may have a conscious desire to rectify unfairness and deprivation.

When asked why they have entered the medical profession, many nurses and doctors answer ‘I want to make people better.’ Sometimes they do not know the answer to this question and may say, for example, ‘I have always wanted to be a nurse.¹ Allen found that many doctors had never seriously considered any other career. These answers indicate that career decisions were made very early on, and that subconscious factors from early childhood probably influenced their choice. Childhood events sometimes remain unresolved until adult life, when life choices might be aimed at reparation or resolution. Choosing to pursue a career in health or social care is one way to achieve this self-satisfaction.

Because of the subconscious element in career choice, it may not be obvious why people sometimes become disillusioned with their work. When workers are unhappy, stressed or unsuccessful in their job, managers and counsellors are more likely to be able to help them if they understand the underlying issues. I hope that these ideas will also be enlightening for carers who want to know themselves better and become more effective in their work.

Conscious choice

Health and social care is a very large employment sector that offers opportunities to workers at all levels, including highly skilled professionals, technicians, administrators, and care workers who need few qualifications. It is likely that many will choose to work in these settings for purely practical reasons. Secure employment in a convenient location may be sufficient to fulfil their needs.

If a person discovers that she has a natural aptitude for looking after people, she may consciously seek to work in a caring capacity in order to make use of her ability. People with a variety of skills may feel that they want to use those skills in a way that helps others. ‘I want to work with people’ is a frequently quoted reason, implying that many people enjoy human contact. For instance, a physicist may get more immediate satisfaction from working in a hospital radiotherapy department, where she can see patients directly benefit from her expertise, than if she worked in an academic research institute where the value of the work is less visible.

Medicine is one of the careers that require an understanding of science. Allen¹ found that, among the young doctors she interviewed in 1986, nearly a quarter of the men and over one-fifth of the women had decided to study medicine because they were good at science subjects at school. Other reasons given in this survey included a perception that medicine is a good and worthwhile career, or to fulfil the aims and aspirations of others.

Careers advice

Justin, a talented boy, was exploring his career options before entering the sixth form at his school. He was particularly bright at chemistry, and decided that he would like to pursue a career in biochemistry. The careers master encouraged him to look at medical biochemistry, and told him that if he chose this career his prospects would be far better if he trained as a doctor and later specialised in biochemistry.

This advice worked out well for Justin, as he became a successful hospital biochemist. He also enjoyed higher status and greater earning potential in the medical profession than he might have had as a non-medical scientist.

Altruism

Unselfish concern for the welfare of others underpins care work and is an important factor for many voluntary workers. However, altruism may not be all that it seems. The rewards may include a salary, public approval and the satisfaction of meeting others’ needs. The invisible reward is the meeting of the worker’s psychological needs. In this sense it is closely linked to compulsive caring, which is explored later in this chapter. Compulsive carers care for others in order to satisfy their own psychological inadequacy. An altruist is able to tolerate the emotional imbalance of a caring role so long as she has other sources of ego satisfaction to compensate. The emotional energy expended on looking after others may be restored by praise from colleagues, friends and family, or by other recreational activities. In other words, altruists keep a balance in their life by developing ways of looking after themselves emotionally.

Financial rewards do not always reflect the importance of work in health and social care, and there may be an assumption that the feeling of doing a worthwhile job will compensate for this. Employers sometimes consciously or unconsciously exploit altruistic workers’ goodwill. In the helping professions there is sometimes a sense of moral obligation to do more than the minimum laid down in the job description. Nurses working on understaffed wards find it hard to leave patients untended if their shift finishes and there is no one to take over their unfinished tasks. They may skip meal breaks because they don’t have time to stop what they are doing.

Recognition that workers are being exploited in this way is slowly gaining ground, but working to rule or campaigning for fairer conditions gives a bad impression. A nurse may feel that she would lose public respect if she held out for better pay and conditions, whereas such behaviour is held to be acceptable for other occupations. It is common for care workers to absorb overload and keep on coping until they are unable to do so any longer. When stress or illness overtakes them they are forced to stop, and they may be unable to return to work for weeks or months, or sometimes not at all.

A bad back

Carol described an insidious build-up of work to meet ever-increasing targets until she eventually went off sick with backache. She was not the only person on the ward to feel the strain — others had also had periods of sick leave. When colleagues were off sick, the workload continued and the rest of the team was expected to take up the work, thus becoming progressively more overloaded and vulnerable to illness.

Carol’s recovery programme included exercises for her back pain. She also decided to work on an assertiveness course that involved learning to say ‘no’ to unreasonable requests. She admired the way some of her colleagues were able to do this, and proceeded to learn how to do so herself. In this way she was able to protect herself from relapse of her pain. She learned that altruism does not include having to say ‘yes’ to all demands. When she became more assertive, she was able to conserve her emotional and physical strength, and she became more effective in her work.

Doctors also sometimes have difficulty saying ‘no’ to overwork. Until recently many hospital doctors had a ‘whole-time’ contract with no specified hours of work. In 1995 it was agreed that junior doctors should not work more than an average of 56 hours per week (or 72 hours in less pressurised jobs), but many doctors still work more than the agreed limit.

In reality the work is never done. There is no point at which the medical in-tray is empty, so each doctor must learn to set their own boundaries. When I worked as a vocational counsellor for junior doctors, I would see a succession of newly qualified doctors every six months to explore their career concerns. With each six-month block the nature of the job would remain the same, but I was struck by how differently the individuals perceived the job. One doctor would say ‘I’m really loving it, it’s busy but I can cope with that’, while another would say ‘I’m totally overloaded, I don’t know how I’m going to get through this.’ Some managed to finish work at a reasonable time, but others regularly stayed on the wards late into the evening.

At this stage in their careers many had yet to learn how to manage their time. The highly conscientious and the perfectionists sometimes set themselves a hard task, whereas the more laid back ones had an easier life. Occasionally help is needed from managers or counsellors to explore how to balance the demands of the service and the ability of the worker to meet those demands. Learning time-management skills and how to prioritise tasks is an important aspect of this process.

Family and other role models

Family tradition has a strong influence on career choice, and not just careers in health and social care. Role models are influential at all stages of development, but particularly during adolescence when children are starting to make their own life choices. Usually the most powerful role models will be parents. In Allen’s study,¹ 18% of male doctors and 14% of female doctors had at least one medical parent. Other significant figures include grandparents, other relatives or family friends. If any of these role models are in the medical or caring professions, there is a strong likelihood that at least one of the children in the family will follow suit. It may be that people from medical families understand the hard work and commitment required to become a doctor, so are more likely to be successful.

On the negative side, if a child senses that there are disadvantages to being a professional carer, they may be put off and choose a completely different career. A child whose experience is that attention is diverted away from her because the patients’ needs are more urgent, or who feels neglected because her parents are working long hours or unsocial shifts, might think that another job would be better.

Sometimes parents have explicit expectations that are conveyed to a child in various ways. Medicine can seem rather like a family business in which succession from parent to child is the norm. It is hard to resist the tradition of several generations of doctors in the family, and this may extend to individual specialties.

Role models also operate at other stages of career progression. When I was offering vocational counselling to junior doctors, I noticed that the choice of surgery as a career specialty was more frequent among women trainees who had worked at a hospital where there was a successful and charismatic female consultant surgeon.

The downside is that if career choices are made to please or appease parents, regret and disappointment may set in later. It is never going to be satisfactory to live out the expectations of other people.

The musician

Stuart is one of four brothers whose parents, both doctors, had emigrated from Eastern Europe in 1939. It was a tremendous struggle for them to overcome prejudice and make a new life in the UK. They were determined that the way for their sons to obtain security and respect was for them to enter the professions of either medicine or the law. Stuart did well at school, but he was more interested in music than in other subjects. He was not allowed to play his instrument at home because of the noise, but he did join the school orchestra.

When exam time came, both his teachers and his parents were shocked at his low marks, and he was made to resit the papers. He still failed to get high enough grades to get into medical school, but he managed to get a place at a school of dentistry, thus satisfying the family honour.

Years later he remained unhappy in his work and at times suffered from depression. When his counsellor asked about his early life history it became clear that he had frustrated ambitions to study music. It was not feasible for him to pursue a full-time course of study, but he did take music lessons and joined a jazz band. He now feels much happier. For him, the final resolution will be achieved when he is able to explain to his parents the emotional cost to him of their ambitions for his career.

Traditions and role models are also often a good influence, pointing to a worthwhile and rewarding career. Paul is an audiologist who is quite clear about what led him into his career with deaf people.²

Helping the deaf to hear

Paul always knew that he wanted to be an audiologist. His interest in ears came less from the heart than from the hearth. He had a deaf grandmother: She was like a second mum to me. Through her I got used to working with deaf people, and that’s what got me into the job.’ He has progressed in his career and now works with children instead of the elderly.

Traditions also come from certain schools which have expectations that students will follow a medical career. Some public schools have a ‘medical’ sixth form for the pupils who are expected to apply to medical schools. Conversely, one junior doctor reported that his prestigious school lost interest in him when it was clear that he was going to apply for a London medical school instead of an Oxford or Cambridge place. It was more important for the school’s league-table ranking to have Oxbridge success than pupil success.

Students who are undecided about career choice may be channelled into a path that suits the school or their family rather than their own needs. They may only realise that they are unhappy several years down the line. Long and specialised training makes it difficult for doctors to change track, although this is not imposs...