Reflective Practice aka The Cosmic Schmuck Principle

The philosopher, mystic and sci-fi author Robert Anton Wilson used to expound what he called the Cosmic Schmuck Principle.

The Cosmic Schmuck Principle holds that if you don’t wake up, once a month at least, and realize that you have been acting like a Cosmic Schmuck again then you will probably go on acting like a cosmic schmuck forever; but if you do, occasionally, recognize your Cosmic Schmuckiness, then you might begin to become a little less Schmucky than the general human average at this primitive stage of terrestrial evolution.

In nurse training, they’re pretty big on the Cosmic Schmuck Principle. Of course, they don’t call it that. They call it reflective practice. The idea being that by regularly reflecting on your own actions and those of your colleagues, you’ll become a “reflective practitioner”, which is kind of the opposite of a Cosmic Schmuck.

Due to certain things going on in my family at the moment, I’m having to spend a certain amount of time visiting relatives on medical and surgical wards. Coming from a nursing background myself, I’ve found myself reflecting a lot on the actions of the nurses scurrying around them, and on my own attitudes to them.

On my last trip to hospital, the nursing care was actually pretty good. As is so often the case in nursing, it’s the little things that were most appreciated. Such as the ITU nurse who helpfully explained that the decision to move my relative to ITU was a routine one for observation, and by the way, I shouldn’t be too worried if the machines start making random beeps and bongs, because they do that anyway. Later on, I had an explanation of what would be happening from a consultant surgeon. He was a bit of a walking surgical cliche, so his explanation basically amounted to, “Slashy! I am a slasher and I like to slash! Slash slash slashy!” The same helpful ITU nurse hung around after he’d left to make sure I wasn’t too vexed or freaked-out by his explanation.

Later on, my relative was moved from the ITU back to the ward. This will disappoint the Daily Mail types who like to lambast the new generation of student nurses as a bunch of too-posh-to-wash essay-scribblers, but while there I found myself quite impressed by a young student nurse who was running around. Eager to help, keen as mustard, good communication style. I imagined the positive feedback I’d have been giving him if I was his mentor.

While experiencing the worries and frustrations that most visiting relatives go through, I wound up thinking a few Daily Mail-esque thoughts of my own. “Why hasn’t that call bell been answered yet? Just what are these lazy cowbags up to? Don’t they care?” Then I took a peek at what the nurses were doing, and realised that they were rushing around doing 101 essential tasks. They were not sitting around the nurses station reading Bella, much as it would have satisfied my indignation if they were.

On other visits I’ve encountered some outright Cosmic Schmuckery. This may be due to me being an RMN, but it’s often the way confused patients are dealt with that I tend to notice. On one visit I wound up having a word with the ward sister because a nurse had dished out the meds for my confused relative, signed for them, then just left them in a pot and assumed he’d take them. When I got to the ward the meds were sitting exactly where she’d left them.

On the subject of confused people, I’m regularly amazed by the number of medical nurses who seem to think the best way to handle an aggressive patient with dementia is to give them a telling-off. For some reason, they then act surprised when they get thumped.

Like I said, it’s the little things that can make the difference in nursing care, and those little things need time. Time to offer reassurance. Time to explain things properly and make sure somebody understands. A little bit of extra time when dealing with somebody who’s confused or has learning disabilities. And of course, that occasional bit of time to reflect on your own practice and make sure you’re not acting like a Cosmic Schmuck.

My worry is that as the cuts go deeper and the wards become more overstretched, that little bit of time may wind up in short supply.

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